ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK JANUARY 2011 • ISSUE 120 Winter claims costs revealed

The latest analysis from one UK-based travel insurance company has revealed that the average cost of a winter sports claim in 2009/10 was £478. Sarah Watson has more details

New claims data from online company insurewithease shows that Eastern Europe has sloped in just behind Austria and Switzerland as the fi fth most popular winter sports destination. France is still the hot favourite for skiing, with 47 per cent of winter sports claims being made by people who headed for the French slopes for some vin chaud. Those looking for skiing or snowboarding holidays are still willing to travel long-haul to reach their destinations, with North America racking up the second highest number of claims for the company at 15 per cent. Of concern for insurers will be the generally higher claims costs seen from tourists who received treatment in the US – it only takes a small number of travellers to make claims from expensive hospitals in desirable ski resorts for the total amount paid by the insurer to reach high fi gures. When it comes to the types of winter sports claims seen by the insurer, 55 per cent are for medical expenses, with fractures and broken bones accounting for 15 per cent of all medical claims. While the average cost of a claim is £478, a serious leg fracture in US resorts such continued on p5 Singapore survey Still uncovered New research from credit card provider According to the results of a survey undertaken commissioned by one of Singapore’s largest direct their insurer if the airline they had booked with went Barclaycard has found that one third of British by Aviva, Singaporean holidaymakers are going on online insurance companies in order to help the bankrupt; 31 per cent did not realise they could holidaymakers jet off without travel insurance. holiday underinsured and are worryingly unaware company better understand the needs of travellers make a claim for the theft of valuable items; and 20 Mandy Aitchison has the details of the survey, of the benefi ts travel insurance can bring a tourist from Singapore, but it actually exposed an alarming per cent did not know that insurance would cover which shows that the message from the travel in need. Mandy Aitchison has the details rate of underinsurance among the population, along medical expenses for injuries caused by accidents. insurance industry of the importance of insurance with high levels of ignorance when it comes to how While ignorance about the product is worrying, the has yet to fi lter through to the buying public The survey by Aviva showed that 51 per cent travel insurance could help. survey also showed a trend for people who do know of Singaporean travellers polled said they go on Perhaps most concerning for travel insurers is what travel insurance does, but choose to think that The fi ndings of Barclaycard’s survey show that when it holiday with no insurance whatsoever on a regular the lack of knowledge from consumers about the it is simply unnecessary. One in four respondents came to buying travel cover, 36 per cent of those polled basis, despite 71 per cent of people admitting to product. A high proportion – 49 per cent – said they to the survey said they felt that insurance is not chose not to arrange it because (famous last words) experiencing major incidents or disruption while did not know that travel insurance could cover a necessary for short trips abroad, while one in 10 they didn’t think they would need it. The study, which on holiday, and 31 per cent saying they have lost missed connection for scheduled fl ights; 41 per cent people aged between 21 and 30 said that it is not was carried out in the UK, revealed that the average a valuable item while travelling. The study was were unaware that they could be compensated by useful ‘at all’. More people continued on p5 Briton risks at least four trips a continued on p5 2 NEWS

IN THIS ISSUE ITIJ CONTRIBUTORS

REGULARS Tatum Anderson is a freelance international health and technology business writer with a decade of experience. News continued 4 Her specialist subjects include emerging markets, business, health and public health policy. She has written for a variety Editorial blog 6 of publications, including The Economist, Guardian Weekly, Insurance matters 8 BBC News Online, the Wall Street Journal Europe and the Company brief 10 Financial Times. Health matters 11 Milan Korcok is an award-winning freelance health Travel matters 12 policy and economics writer who covers travel insurance, public health, and medical education issues in Canada and IPMI news 16 the US. He has been writing about health fi nancing and Cross-border care 18 policy issues in these countries since the 1960s, is a frequent contributor to leading North American professional journals Air ambulance news 20 and consumer media, and is publisher of the consumer Profile: Mark Lee 38 website www.travelinsurancefi le.com. He lives in Fort Lauderdale, Florida. Service directory 39 Grapevine 46 Karyn Paskett currently works as a co-ordinating nurse On the move 47 for International SOS, a provider of international healthcare, medical assistance, and security services. She regularly participates on commercial medical repatriations. Paskett is an Australian trained registered nurse specialising in intensive care with a focus on helicopter and light aircraft retrievals. Prior to joining International SOS, she worked in numerous intensive care units including a specialist neuroscience unit in FEATURES Australia, the UK and the Channel Islands.

News Analysis: Licensing uniformity in the US 22 A move that could change the face of travel insurance sales

Feature: Digital marketing Part II 26 How insurers can make good use of the latest marketing techniques

Feature: Trauma on the slopes 28 Airlifting injured skiers and snowboarders can be a complex operation

Assistance & Healthcare World Markets: Dubai 32

ITIJ TEAM

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

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

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4 NEWS

Quebec travel insurance distribution guide: a model for America? Claims made easy

As American travel insurers move to unify criteria spelled out in the AMF’s drafting manual – • And it must state that the insurer is aware that As Australians gear up for their traditional summer licensing standards and consumer protection sort of a model blueprint. To activate the Guide, the other insurance products offering similar coverage holiday period, local firm Travel Insurance Direct controls among sellers of their products nationally insurer must declare, in writing to the AMF, that it are available in the marketplace. (TID) is advising travellers to take some simple (see News Analysis US Licensing uniformity in the complies with Quebec laws and regulations and that To date, Quebec’s Distribution Guide regime has not precautions to assist them with any holiday claims. US on p22), travel insurers in Canada’s Quebec it meets the requirements of the Act – which means been taken up by any other province, but Faribault TID general manager Ian Jackson said that while province move ahead with a somewhat similar it accurately reflects the product being distributed. sees it as such a ‘magnificent opportunity’ to open up most Australians would enjoy an uneventful holiday, initiative. Milan Korcok reports So as to ease up any potential administrative backlog, the selling of travel insurance products through non- a small but important proportion would inevitably the AMF allows the insurer to start selling its product insurance personnel, that’s it’s just a matter of time experience an incident or emergency that would The Canadian programme allows non-licensed the day it submits its Guide for approval on the before the system spreads to other provinces and result in a call to an insurer. He told travellers: “If personnel to sell their products while guaranteeing strength of its declaration that it is in compliance. ‘change(s) the way we are selling insurance products you’re with a reputable travel insurance provider and consumer transparency. Quebec’s Distribution Ultimately, the AMF will review the Guide and it may in Canada’. have a legitimate basis to make a claim, then there Guide regime, in effect since 1999 but under ask for further documentation or should be no issue at all. However, the whole claim constant evolution since, allows insurers to offer clarification. But, Faribault says, process can be made far simpler and quicker by their products through agents and non-insurance there is ‘really nothing very scary taking a few precautionary steps like keeping receipts personnel who sell products for which insurance is about it’. “I have seen a 10-page and emailing images of your valuable items to a safe only an accessory. Under the regime, the insurer leaflet folded in half that did the location.” He added: “If you are a victim of crime does not have to be located in the province so long trick,” he said. Some insurers while you’re on holidays, you should also make as it is registered with the Autorité des marchés even have the Guide set up in sure you get a copy of the local police report. It’s financiers (AMF – Quebec’s financial services PDF format to allow their far-flung something that people often forget in the heat of the regulator) to sell products in the province. The distributors to print them out on moment, but it makes it so much simpler to make a end line distributor must, however, be located in demand. In an area as vast as claim if you have all the necessary documentation on Quebec. Travel agents and other sellers offering the Quebec, which extends from the hand and don’t have to chase it after the event.” insurance product must first provide the consumer US border to the Arctic, and from The company has thus prepared a list of 10 points the Guide, which clearly outlines what the product the Atlantic Ocean to almost the for travellers that could assist them in the event of a covers and what it excludes. The Guide – besides Great Lakes, ‘far flung’ has a literal claim. In addition to the points mentioned above by meeting strict standards approved by the AMF, must meaning. Jackson, the list urges travellers to check the limit on also be at a grade five reading level. The process for using the Guide is the baggage clauses of their travel insurance policy to Speaking to a meeting of the Travel Health Insurance clearly defined by the AMF: ensure that what they have packed does not exceed Association of Canada (THIA) last year, Christian • The insurer may not offer a product through a that limit, and if buying something expensive while Faribault, a partner in the Montreal-based Borden distributor without first handing over a Distribution Rate increases mean on holiday, to take a photograph and make sure the Ladner Gervais legal firm, admitted that as good as Guide and the Guide must be given before travel receipt is stored in a safe location. It also encourages the Distribution Guide is, ‘you can’t replace a good insurance is purchased; survival travellers to make sure they take their travel insurance representative’. But the Guide does allow • It must describe the product offered, the nature of insurance policy number with them, ideally loading it insurers to offer products where they don’t have coverage, and must describe clearly all exclusions According to the chief executive of one of the largest into a mobile phone or laptop and sending the details offices through firms and personnel who don’t sell from the guarantee of coverage; travel insurers in the world, Mondial Assistance, the to a web-based email address so that it is accessible insurance as their first offering. • It must also specify how and when claims may insurance premium rate increases either already wherever and whenever needed. The actual Guide, first step in any sale, is not a unitary be submitted and what steps may be taken if the instituted or coming soon ‘are the only way to survive’ product but is written by the insurer according to insurer disallows a claim; in these difficult times. Mike Webb believes that the travel insurance industry has to act fast to improve profitability and therefore stabilise the sector, and Carefree attitude is challenging the industry to tackle the ‘enormous commoditisation of the sector’ that has seen prices fall caution steadily while costs for insurers have increased. Webb said: “Despite the fact that many companies Australians’ carefree attitude may be putting them at continue to lose money on travel insurance and risk of incurring significant costs, potentially turning the larger players are increasing rates, we still see their dream holiday into a nightmare. A survey too many underwriters quoting prices that can only commissioned by Bupa Australia – which provides produce significant losses for their companies, or travel insurance under the brands MBF, HBA and they wish to increase premium income and gain Mutual Community – has found that 55 per cent market share, at the detriment of their bottom line. of all respondents purchase travel insurance based The continuing increase in medical costs, customer on their perception of a destination’s safety. Nearly expectations, insurance regulations and changes in half of all respondents to the survey said they customer demographics mean that rates need to perceived Africa as the riskiest destination in terms increase by 20 per cent to 30 per cent across the of representing a high potential for travellers to be board, if the industry is to return to realistic long- involved in a robbery, accident or unexpected illness, term profitability.” while New Zealand was cited by respondents as Webb believes that premiums for travel insurance being the safest destination. need to more accurately reflect the prevalence of According to the results of the survey, South America risk for modern travellers, which means they simply was perceived as being the second most dangerous have to go up. He went on to say: “Insurers have destination by 31 per cent of those polled, followed continued to experience large losses and rising by Southeast Asia at 14 per cent and North America costs whilst providing cover at rock bottom prices. at six per cent, while less than two per cent of people Furthermore, people buying travel insurance without thought that Europe was a dangerous destination. declaring a pre-existing medical condition has had Other key findings include the revelation that a huge impact on the industry, leading to increased Australians’ greatest fear while travelling overseas is costs, which inevitably get passed on to consumers. not, as many might think, getting caught up in a terror The focus for those offering travel insurance to their attack. In fact, it is losing their luggage, passport and customers should be on creating a comprehensive credit cards. Shane Williamson, head of distribution product that offers an appropriate level of protection strategy and complementary products at Bupa for the customer and their travel needs, rather than Australia, cautioned travellers against tempting fate being driven by cost.” Part of the problem is the and putting themselves at risk of being left without ever-widening gap between consumer expectations support in a foreign country: “Unfortunately, it and the product itself, he added: “I think consumer appears that some Australians believe they only expectations are currently very high, despite many need travel insurance if they’re running with the paying very little for the product. Hence travel bulls or engaging in daredevil behaviour, which is insurance often comes under the spotlight when simply not true. The reality is that we processed there’s focus on customer satisfaction. But if prices over 2,500 travel insurance claims last year, and the rise industry-wide, this will provide the investment majority of incidents occurred in destinations that for the development of products that more closely fit were perceived as safe, with most claims related to customer needs and expectations. And this, in turn, common occurrences such as lost luggage, travel should address the issue of customer satisfaction.” cancellations, or requiring medical treatment.”

International Travel Insurance Journal NEWS 5

Still uncovered AXA snow concern ABTA shows lack continued from p.1 UK travel insurer AXA has warned that as of cover year without suitable travel insurance in place, with many as a million Britons could be at risk when The Association of British Travel Agents (ABTA) has 42 per cent of respondents saying that it is either too they go skiing this winter, as according to the released a survey that shows that almost one in five expensive or ‘too much hassle’. A further one in five firm’s research, one in six UK adults enjoy holidaymakers from the UK travel abroad without people said they simply forgot to arrange cover as they taking part in a winter sport while on holiday, insurance. The survey, released during the association’s were too busy trying to organise the family, or renewing yet 10 per cent of them will do so without annual Travel Convention in Malta, revealed that 17 their passport, and one in 10 people were too insurance. AXA’s figures showed that 25 per per cent of British tourists don’t deem travel insurance preoccupied thinking about what to pack, rather than cent of people who do go on a winter sports to be an important purchase. According to the results what would happen if they lost their precious baggage. holiday will rely on their annual travel insurance of the poll, around 12 per cent of travellers have made The high number of people who have ventured abroad policy, but only half of that number will actually a claim on their travel insurance in the past five years, uninsured led to one in 10 respondents to the survey check to see if that policy is suitable for a skiing with three per cent of claims being in excess of £500. being caught out on holiday because they didn’t have or snowboarding holiday. Amanda Edwards Mike Monk, head of finance at ABTA, said: “It’s very the right cover. Thirty-two per cent of people paid out of AXA acknowledged that holidays are concerning that 19 per cent of holidaymakers are to replace lost luggage; 30 per cent had to buy a new expensive and money is tight for many people, going to other countries without insurance, running handbag or camera after theirs was stolen; while 23 per but warned that cutting insurance cover was a the risk of having to pay huge medical bills. More than cent had to pay for their own medical bills. false economy that could expose travellers to half of them are also in danger of not being covered The findings go on to show that 73 per cent substantial costs. for cancellation charges from redundancy or illness.” of Britons feel that it is important to have travel insurance, yet one in 10 people had ruined their holiday by not taking it out, and spent their holiday worrying about the lack of cover and avoiding certain trips and activities due to the concern. Commenting on the findings, Katherine Whitton, UK marketing director for Barclaycard, said: “Travel insurance really is a holiday must-have, and it’s essential that any policy covers all aspects of what travellers may find useful when on holiday.” Winter claims costs revealed continued from p.1 as Colorado or Lake Tahoe could cost as much as $43,000, or in certain resorts in Eastern Europe £10,000. Ian Gilmour of insurewithease commented on the findings of the company’s survey: “Whether snowboarding, skiing or tobogganing, we urge travellers to make sure they take the right precautions and get a good winter sports travel insurance policy as well as a ski pass. Almost 40 per cent of claims in 2009 were made by people in their 20s and only five per cent by people over 50.” He added: “Those travelling without insurance risk huge medical bills. Even a short trip can end up costing thousands if someone falls ill or has an accident, so travelling with the right level of cover is crucial for that added peace of mind.”

Singapore survey continued from p.1 in this age bracket thought that insurance was an unnecessary evil than realised its importance. Paul Jackson, head of general insurance for Aviva Asia Pacific, commented on the findings of the survey: “We were shocked to discover that so many people are exposed to flight delays, lost baggage, medical expenses and a host of other unforeseen circumstances, which are sadly a reality of modern travel. All of these things and more are covered … by travel insurance … [which] costs less than a tube of sunblock!”

Which? rewards

UK consumer organisation Which? has named the Environmental Transport Association as its ‘Best Buy’ for travel insurance for travellers between the ages of 65 and 74. The magazine published by Which? analysed 22 aspects of travel insurance policies and presented the results in a league table showing which companies it believed provided the best all-round cover to travellers. A spokesperson at the ETA said: “The Which? report shows that older travellers can get a premium travel insurance policy at a decent price.”

www.itij.co.uk 6 NEWS

Safety not a UK report priority released

Research by UK travel insurance Research and Markets has specialist Essential Travel has revealed announced the release of its that almost 40 per cent of its ski and latest report, UK Travel Insurance May I wish a happy and prosperous New snowboard customers will not be 2010, offering readers a Year to all our ITIJ readers, and my best in wearing a helmet this season, despite valuable source of information particular to both people who actually take a staggering 75 per cent of them on the UK’s travel insurance the time to read my column (thanks Mum admitting to suffering an accident on marketplace. It provides and Dad). the slopes in the past that was serious analysis and data for market enough to require medical assistance. In sizes, consumer trends and the Now, it’s a New Year and what wonders response to the customer poll, Essential key competitors in the travel will it bring? Well, there’s the anticipated Travel has teamed up with a mountain insurance sector. The report also surge in the purchase of travel insurance sports retailer and brain injury charity includes information on market from bankers leaving Europe because of the Headway to launch a safety campaign to drivers and forecasts where the new EU restrictions on pay/bonuses. Does encourage skiers and snowboarders to industry is heading until 2014. this mean, you ask, that fine upstanding wear a helmet this season. As part of the ‘Use Your Highlights of the report include confirmation that bank employees in the mould of the Nick Romanian market Head’ campaign, Essential Travel is offering to donate economic uncertainty among UK consumers, the Leesons, (Barings … who? Exactly!!), Jerome £1 to Headway for every winter sports policy it sells. expense of longer-haul flights and the exchange rates Kerviels (BNP Paribas), Fred Goodwins drops Stuart Bensusan of Essential Travel said: “On first between the pound sterling and foreign currencies (RBS) or Andy Hornbys (HBOS) will all be glimpsing the poll results, we were relieved to see that According to Insurance Profile, in the first nine months have led to a lower propensity for travel. It is also leaving Europe’s financial centres? Yes ... if the majority (62 per cent) of skiers and snowboarders of 2010, travel insurers in Romania underwrote shown that travel underwriters have stated, in the god’s are merciful, yes. do plan to wear a helmet this season, but an premiums of c7.6 million, a 10-per-cent drop from conjunction with figures from the Association of And on the negative side, well, who knows alarmingly high percentage of people are still intent the same period in 2009. The market leader is British Insurers, that they have been increasing their how the austerity measures introduced on not wearing one. What’s more, when we probed Generali Asigurari, which, with the takeover of the premium rates. However, due to the lower pricing worldwide will affect the numbers of our customers further we found that only 25 per cent RAI Asigurari portfolio, has a market share of 33 per and increasingly popularity of packaged annual cover, c people travelling? It certainly won’t help of the customers who had sustained serious injury cent. In second position is Astra with 1.1 million in the overall average price for travel insurance has boost the number of travellers in the short whilst skiing or snowboarding in the past were wearing gross written premiums, while City Insurance was in actual fact decreased for most consumers. The term. And less travellers usually means helmets at the time. Of those who were wearing a ranked third in the marketplace. report notes that the most important difference for fewer insurance policies, funnily enough. helmet when they had their accident, 67 per cent felt The report into the Romanian travel insurance the travel insurance market between 2009 and 2010 that it saved them from a more serious injury.” industry shows that market concentration is high, was the increase in the number of radio campaigns Let’s just hope the volcanoes behave Peter McCade, chief executive of Headway, said: with the top five companies in the market generating run by travel insurers. In 2000, radio advertising themselves this year. “Encouraging skiers and boarders to wear helmets more than 72 per cent of the total premiums, and made up just 0.2 per cent of the total industry is hugely important to us. There is a general the top 10 insurance companies together comprising advertising spend, but in 2010 this rose to 3.1 per misconception that only a major impact will lead to a market share of 97 per cent. In recent years, the cent. Overall, though, travel insurance marketing death or disability from a head injury, however, the market for travel insurance in Romania has increased spend fell by more than 25 per cent in 2009. truth of the matter is that even minor bangs to the significantly as travellers are obliged to purchase Showing that the number of visits abroad made head can have serious consequences.” it before they travel, but fewer travellers in 2009 by UK citizens dropped by 15 per cent in 2009, and 2010 have led to a the report also predicts further decreases in travel Ian Cameron contraction in the market. numbers and policy sales, leading to the market Editor-in-Chief In 2008, c13.1 million was contracting. [email protected] written in travel insurance Elsewhere, the report shows that total travel premiums, followed by insurance gross written premiums fell by three per c10.4 million in 2009. cent in 2009, and profit margins for travel insurers Challenges to travel insurers are also under pressure. However, it was found Trials for travellers operating in the market, that 88 per cent of UK consumers who travel apart from economic overseas do take out some form of travel insurance Peter Hayman, director of PJ Hayman Travel pressures on travellers, before they go, whether or not it is packaged with Insurance, has commented on the dreadful year include the European Health a credit card or bought independently. In terms 2010 was for travellers, underlining how travel Insurance Card and the of competitive dynamics, the report said that the insurance could have helped them to deal with inevitable seasonality of sales corporate partnership space is seeing a number stressful and unpredictable changes to their travel of insurance – the insurers of developments, one of which is that Munich Re plans. Starting off with the recent wildcat strike by only really make a profit in has joined the top five players in the UK’s travel air traffic controllers in Spain, Hayman continued: the summer months. insurance market. “The year has been bookended by exceptional snow and ice, which caused huge disruption, as did the ash cloud in April. Strikes have added to the misery with a series of actions by British Airways cabin crew FCO issues ski warning during March, May and June. Protests in France, Business picks up Greece and Belgium added to the list of problems, As millions of Europeans head for the slopes this claim on the map is shown to be £23,000, which which has seen a total of 12 delay events [in 2010].” winter season, new research from the UK’s Foreign was the cost of a tourist sustaining a spinal fracture the tab Hayman pointed out that while airlines and tour and Commonwealth Office (FCO) has revealed while skiing in Argentina. operators have primary responsibility for sorting that almost one third of people in the UK admit In addition to warning skiers and snowboarders of the A firm in the north of England has paid a £28,000 out their travellers affected by adverse weather to not taking out travel insurance for their winter importance of having travel insurance in place, tourists air ambulance bill to bring a stroke victim and conditions or other problems, travel insurance still sports holidays. The FCO has thus issued a stark were also warned about mixing alcohol and winter member of staff back to the UK from Egypt after plays its part. The problem, he said, is that many warning to tourists: “If you are injured while skiing or sports. The FCO states: “Heavy drinking is often a she suffered a devastating collapse on holiday and people do not check whether or not their policies snowboarding, you could face a bill for thousands of key factor in many consular cases linked to skiing and her insurer refused the claim. Lynne Woodward will provide protection for delays caused by snow, pounds if you are not properly insured. A helicopter snowboarding. As well as putting yourself and others was in Sharm el-Sheikh when she suffered the or other reasons for not reaching a destination, and ambulance and medical repatriation could cost you at risk, if you are involved in an accident while under stroke, but when her husband tried to make a the lack of consistency across travel policies does not many times the price of your holiday, so you should the influence of alcohol your insurance cover may be claim, he discovered the age-old problem of aid travellers. He further explained: “Travel delay and always get comprehensive travel insurance and check invalid [and] as a result you may have to pay thousands pre-existing condition declaration (or lack of it). disruption cover will usually provide for a fixed sum exactly what is covered in the small print.” The FCO in medical expenses if you are injured.” The couple failed to realise that an earlier episode for each 12 hours of delay or allow you to cancel pointed out that consumers could need to buy extra Dr Laurence Bristow-Smith, British consul general of ill health suffered by Mrs Woodward in early your trip if delays exceed 12 or 24 hours. Some coverage if they wish to do something a bit different in Milan, Italy, said: “We’ve provided support in a November 2010 had rendered their travel cover will go further and cover additional costs if public on their winter holiday, for example, skiing off piste. couple of consular cases where fatal accidents in the void. Mrs Woodward had been seen by doctors transport fails to get you to your departure point on To drive home the importance of travel insurance mountains were a direct result of drinking too much after she lost peripheral vision in her left eye, but time.” Hayman added: “Missed connection costs are cover, the FCO website currently has a map that alcohol. In one case, the insurance company refused she was told later she was fit to fly. Commenting on not covered by many policies, but are increasingly shows examples of insurance claims by British skiers to pay out as the policyholder ‘had put himself in the situation, Mr Woodward said: “I couldn’t believe important if travellers seek to save on their flight costs who have broken bones in the world’s hotspots and unnecessary danger and was under the influence of it when the insurance company said we weren’t by using European hubs to avoid the new high rates gives the cost of medical bills and repatriation back alcohol’. This meant that repatriation costs, amounting covered. They said they had contacted our GP, who of Air Passenger Duty.” to the UK following the injury. The most expensive to thousands of euros, had to be met by the family.” told them Lynne had suffered a mini-stroke.”

International Travel Insurance Journal NEWS 7

www.itij.co.uk 8 INSURANCEMATTERS

Swiss Re predicts global growth NEWSWIRE Swiss Re’s economists predict that growth in the commented: “Insurers, pension funds and private Thomas Hess continued: “Current rates are not insurance and reinsurance industry will continue to savers are paying for the cheap financing of sustainable even when interest rates start to correct. Up to five new takaful firms, backed by accelerate in 2011, but have warned that financial governments, and for households and corporations A correction in premium rates is overdue, but we strong existing entities, are expected to launch in turmoil could derail global economic recovery. that borrow.” may have to wait until 2012 for that to materialise.” the UAE by mid-2011, according to local media According to the company’s latest report: “Industry According to Swiss Re’s economists, the risk of over- The primary life and health sector is recovering, with reports. At least four companies have applied for capitalisation exceeds pre-crisis levels; premiums are regulation in the insurance industry also remains high. global premium income in this sector up by 4.3 per licences, said the chief operating officer of Abu growing in most segments and most countries; and While the European Union Solvency II regulatory cent in 2010. The primary life insurance industry will Dhabi National Islamic Finance. many emerging market countries are performing initiative is generally welcome, it is likely to lead be back on track in 2011, but low interest rates will particularly well.” Profitability is set to remain under to higher capital requirements for many insurers if continue to weigh on profitability. GulfCap Investments, the principal pressure, however, since investment returns are the implementing measures stray too far from the However, there has only been moderate growth shareholder of Gulf African Bank in Kenya, has dampened by low interest rates and reinsurers will original economic-based principles. seen in the life and non-life reinsurance sectors, set up an Islamic insurance company targeting therefore need to maintain underwriting discipline. “Regulators’ overly conservative view of the although non-life reinsurance is currently faring better members of the Muslim community. The company Looking ahead, a key problem identified by Swiss Re insurance sector is not justified: insurers emerged than the primary non-life insurance industry. For will operate as Gulf Takaful Company Ltd. is that regulatory factors will force insurers into low- from the crisis largely unscathed and banks were 2010, a combined ratio for the industry of 96 per yielding government bonds, increasing the risk that found to be the source of the problem. While the cent is estimated, helped by releases from prior year The insurance sector in Bangladesh has they miss out on a market upturn. insurance industry does not object to being part claims reserves. Insured losses in 2010 are close voiced concern over a delay in the formation of “The global economy expanded modestly in 2010 of systemic risk monitoring efforts as a means of to the long-term average for the industry – high a new regulatory authority under the country’s and is expected to show moderate growth through averting future crises, it opposes the systemic risk losses during the first half of the year were offset by recently passed Insurance Law, which has made the 2011,” Kurt Karl, Swiss Re’s US chief economist, supervision of insurance groups because its core a benign US hurricane season. Growth expectations existing Insurance Department virtually inactive. said. “Developed and emerging markets have parted insurance activities are not a source of systemic risk. for the non-life reinsurance industry are moderate, ways on growth, with emerging markets booming Efforts should be dedicated instead to enhancing but profitability is expected to erode as rates decline. The People’s Daily newspaper in China while developed economies are growing at a more group supervision,” Kurt Karl added. Companies that can deploy superior underwriting has reported that the Chinese Insurance Regulatory modest pace – a situation that is set to continue Swiss Re’s report into the global insurance industry skills to navigate towards the right segments and Commission has found several problems in the in 2011 and 2012. Monetary policy in the major continued by saying that premium growth in non-life risks, though, will have a competitive edge in the management of property insurers during inspections economies is not expected to tighten substantially and life insurance is expected to accelerate in 2011, coming years. that were carried out in the first half of last year. next year, because inflationary pressures remain benefiting from the economic recovery and further Life reinsurance is expected to grow moderately subdued and certain EU economies face fiscal crises.” improvements in financial markets. The report overall, with stagnation in industrialised countries Munich Re is to insure a project that covers Growth in developed economies is expected states: “Expected growth for non-life insurance in offset by annual growth of around 10 per cent in co-operatives in the Philippines against extreme to accelerate slightly in 2011 and 2012, but will developed economies is three per cent after inflation emerging markets. Longevity and large transactions weather events. It has teamed with the German remain close to its long-run averages of 2.5 per and in emerging markets between seven per cent are particularly interesting potential growth areas for Agency for Technical Co-operation and Philippine cent to three per cent in the US, 1.5 per cent in and eight per cent after inflation. Non-life premium life reinsurers operating in mature markets. insurer Coop Life Insurance & Mutual Benefit Japan, and approximately two per cent in Europe. rates have been deteriorating now for several years.” The booming emerging market growth looks set to Services to protect the loan portfolios of co- Emerging markets are forecast to grow continue, according to Swiss Re: operatives from events such as hurricanes. rapidly next year, leading to increasing “The emerging market countries inflationary pressure in several markets. performed well during the financial Bancassurance is growing in many Asian Benchmark interest rates in developed A risk remains, however, that the crisis of 2007 to 2009, partially due markets, boosted by de-regulation of the banking economies are expected to remain low to the strength of China, which sector and insurance companies intending to through the end of 2011, but long-term economic recovery will be derailed continued to import raw materials optimise distribution via banks, according to US- interest rates will rise gradually as the and was only minimally affected based research firm Celent. world economy improves. by renewed financial market turmoil, by the global downturn,” said Kurt A risk remains, however, that the Karl. “Because these countries Shanghai’s shipping and cargo insurance economic recovery will be derailed resulting in part from a potential have been growing well and business has grown far ahead of the national by renewed financial market turmoil, recovered robustly, they are now average as the city taps its potential as a shipping resulting in part from a potential widening of the eurozone debt crisis close to their growth potential, so hub, according to the city state’s insurance widening of the eurozone debt crisis. inflationary pressures are rising.” regulator. Karl said: “Although the recovery is The outlook for emerging nearly 18 months old and broadening, market economic growth Holding their inaugural meeting at the investor trust in its continuation is still remains favourable in 2011, Chartered Insurance Institute, the members of weak. Instability continues in several with rising consumer sentiment, the MENA Insurance CEO Club (MICC) took important real estate markets including supportive government policies stock of what makes London one of the world’s the US, Ireland and Spain. Despite the and improving labour market best insurance centres, while also sharing their support received from the International conditions all set to boost expectations for the region with UK-based Monetary Fund and the European domestic demand in the near underwriters. Union, there are still concerns as to term. Over the next decade, the whether Greece and Ireland can cope global economy is expected to Marsh has signed an agreement with with the problems they face.” expand on average by 3.8 per Jordanian company Anglo Arab Insurance Low interest rates as a result of cent annually. In the period 2011 Brokers to co-operate on insurance coverage, expansionary monetary policy in to 2021, emerging markets as a risk management and claims handling issues for developed economies were also whole are forecast to grow twice companies in the energy, power and aviation sectors identified as a key challenge for as fast as industrialised with operations in Iraq. insurance companies. Thomas economies – at 5.9 per cent Hess, Swiss Re’s chief economist, versus 2.4 per cent. Abu Dhabi National Insurance Co. achieved net profit of AED128.5 million (US$35 million) for the nine months ended 30 September 2010, up from AED20.6 million during the same period a Underinsurance worry for Australians year earlier, driven by gains in net investment and other income. Independent superannuation and investment product Industry (Supervision) Regulations 1994. whether or not commissions on life insurance sales provider Wealthtrac has researched the possible Wealthtrac polled 36 independent advisers, 53 per within the superannuation market are banned, the Dutch banking and insurance group ING has effects of the current proposal to ban insurance cent of whom indicated that a ban on commissions responsibility to ensure the best outcomes for clients said it is planning two initial public offerings for its commissions in superannuation sales, finding that such would serve to exacerbate the underinsurance would remain with the advisers. The research also insurance activities as part of a split of the group. a ban could worsen Australia’s continuing problem problem. “However,” said Wealthtrac managing showed that more than half of the advisers polled Direct banking activities have offset weak insurance of underinsurance. Superannuation is a retirement director Matthew Johnson, “an overwhelming believe that less than 40 per cent of their clients are income for the group in the past year. (including pensions) programme in Australia. It majority of advisers – 63 per cent – indicated adequately insured, and not one adviser said that has a compulsory element whereby employers that if life insurance available via a platform was to more than 80 per cent of their clients are adequately According to McKinsey, despite the strong are required by law to pay an additional amount encompass the benefits of retail insurance, then the insured. The major reasons given for the lack of economic problems faced by insurers in the wake of based on a proportion of an employee’s salary and underinsurance issue may improve.” He added: “If insurance coverage are cost, combined with a lack the global financial crisis, top performing insurance wages (currently nine per cent) into a complying you need something sold in order for people to take of education around insurance products, and the companies outdid their peers on costs as well as superannuation fund, which can be accessed when it up, you actually need to pay people who are selling potential for people to think they are better covered operational strength and produced more robust the employee meets one of the conditions of release it a reasonable amount of income.” than they actually are – particularly those people who revenue growth. contained in Schedule 1 of the Superannuation Those polled by Wealthtrac agreed that regardless of do not have a financial adviser, according to the panel.

International Travel Insurance Journal INSURANCEMATTERS 9

Healthcare Quality concerns over IASB Draft premium Lynda Sullivan, executive vice In particular, Ms Sullivan highlighted that the discount president and controller of rate issue was particularly problematic as socio- possibility Canada’s Manulife Financial economic factors dictate product offer and selection, (pictured), has said that the and assets that are available for investments vary The extension of the Indian International Accounting greatly by geography. Instead, Ms Sullivan called for government’s flagship Standards Board (IASB) could a dialogue on an alternative discount rate, ‘which health insurance scheme slow down and allow for would work within the spirit of the existing proposal – Rashtriya Swasthya more time to examine the and conceptual framework, yet support the business Bima Yojana (RSBY) – to issues related to the Exposure model for long-contract insurers’. the above-poverty-line Draft (ED), so that the new Ms Sullivan was not alone in her opinion, as Rob population of the country accounting standards can work Esson, chair of the Insurance Contracts Sub- could lead to an increase in within all business Committee, premium income of around models. Speaking at agreed that a Rs50 billion (US$1.13 the recent International risk-free discount billion) for non-life insurance Association of Insurance rate, or one companies over the next Supervisors annual with only a small two years. According to the conference in Dubai, Ms liquidity premium, executive director of Amicus Sullivan told delegates: could cause Advisory Sanjay Pande, “Manulife is not significant losses the estimate that insurance firms would earn an convinced that the quality of the Exposure upon inception. incremental premium of Rs50 billion is ‘reasonable’. Illegal activities Draft is of high quality. It feels that the IASB is He said that the Amicus Advisory is a consultancy firm that aids working towards a deadline and that this will practice could various state governments with implementation of clampdown sacrifice quality.” result in insurers the RSBY. On 30 July 2010, the IASB issued its raising their prices One labour ministry official told local newspaper The China Insurance Regulatory Commission (CIRC) Exposure Draft on Phase II of the insurance to make up for the The Financial Chronicle: “Around three to five per has warned that it will be ‘unrelenting’ in its efforts to contracts project, which is intended to losses, stop them cent of the population is covered through individual crack down on illegal activities by insurance agents, result in a single consistent recognition offering certain and corporate health insurance policies at present, such as illegal financing and pyramid selling. The and measurement standard for insurance products, or while 27 per cent of the population that is below warning to agents came from CIRC after two cases contracts around the world. Comments simply force them the poverty line is covered through RSBY. So what of illegal activity came to the attention of the local were welcomed until 30 November, and to ‘take the loss we are now looking at is bringing 40 to 50 per cent insurance regulatory bureaus in the Liaoning and the IASB has said that it hopes to have a on the chin’. of the above-poverty-line population under RSBY. Zhejian provinces. In the Liaoning case, the head of final standard worked out by the middle of this year. In response, Dr Elke Koenig, an IASB board member, These would be domestic workers, rickshaw pullers, the Chende Insurance Agent Company He Feng was Ms Sullivan believes that the full implications of the said that while the organisation is committed to vendors and sanitation workers who may not be detained for collecting funds at high interest rates, Draft were not considered, stating: “Many of the ‘getting the project across the finish line’, it would not categorised as below poverty line, but who still while in Zhejiang, the licence of the Hangzou Minfeng recommendations (were) made in the first half of be ‘rushing to meet the end of June 2011 deadline’. cannot afford health insurance cover.” Insurance Agent Company was cancelled after the firm 2010. In fact, the scope of the first round of the field She has urged the insurance industry to come up M. Ramadoss, chairman and managing director of reportedly tried to tempt prospective customers by testing was such that the full impact of the current with alternative ideas and suggestions rather than just New India Assurance, praised the move to bring exaggerating potential earnings. recommendations could not be assessed.” dismiss the Exposure Draft. more people into the health insurance fold. He The CIRC must tread carefully, however, as agents commented: “The government is targeting the play a vital role in the country’s insurance industry lowest strata of the above-poverty-line population – total premium income generated by insurance that is not aware of the benefits of health insurance. intermediary channels, which includes agencies, The move would develop an appetite in them for brokers, agents and banks, reached ¥587.48 billion health cover.” (US$88.4 billion) in the first half of 2010, accounting Since the RSBY was introduced in 2008 to cover for over 73 per cent of the country’s total premium people below the poverty line, it has generated income. Of the total premium income in China, premium income of between Rs8 and 10 billion insurance agencies accounted for ¥18.83 billion, up for non-life insurance companies in India, covering 22.8 per cent year-on-year; brokers accounted for 20 million families. The key aim of the scheme is to ¥12.79 bullion, up 13.6 per cent; and reinsurance provide protection to below-poverty-line households premiums generated from insurance brokers for financial liabilities incurred when family members amounted to ¥377 million. As of June 2010, China are hospitalised. Beneficiaries of the scheme are had 2,538 insurance intermediary institutions, 156,000 entitled to hospitalisation coverage of up to Rs30,000 concurrent insurance agencies and more than 3.02 for most of the illnesses that require a hospital stay. million insurance sales agents, according to the CIRC.

BIBA and AMII launch standard

The British Insurance Brokers’ Association (BIBA) and Peter Staddon, BIBA’s head of technical services, said: the Association of Medical Insurance Intermediaries “We have put these documents together to address (AMII) have together announced a new industry market issues of uncertainty and customer confusion standard template for private medical insurance where some letters of authority have been mistaken (PMI) authorisation forms, which includes a new for letters of appointment. We are pleased to put this standard review period of 90 days. The new form is new industry standard in place to help address these designed to address issues of market uncertainty by issues for our members.” clearly establishing the options a new customer has in Andrew Tripp, chairman of the AMII, added: “With dealing with an intermediary or broker; and where a the AMII/BIBA PMI panel, we have established customer only wishes a new intermediary or broker a forum that has allowed constructive dialogue to review their existing policy, by setting out a clear between insurers and intermediaries within an timescale for the review period. The new form and environment of mutual respect. This new standard industry standard is the first initiative to be launched form will improve consumer confidence in our by the AMII/BIBA panel, a group that was established profession and bring a level of uniformity across the in 2009 to bring together insurers and intermediaries market in how letters of authority or appointment to discuss some of the issues of common concern are handled by insurers and intermediaries.” He within the PMI industry. The panel currently includes added: “With the support of the UK’s leading PMI representatives from nine of the UK’s PMI insurers, insurers, I am confident that this will be the first of who between them represent more than 95 per cent several initiatives from the panel that will improve of the UK’s PMI market, as well as representation standards of service within the health insurance from BIBA’s Healthcare Focus Group and AMII. sector for intermediaries and our customers.”

www.itij.co.uk 10 COMPANYBRIEF

Barclays improves Airspace closure cover covered

Barclays Bank in the UK has launched a new and UK-based online travel insurer Insurewithease is bespoke travel insurance product following its three- extending its policy options to offer airspace closure year deal with FirstAssist. The new and improved cover, providing financial assistance in the case of travel insurance offering from the bank includes a airspace, airport or port closures following a natural new ‘QuickQuote’ system that allows Barclays to disaster. Sarah Findlay, online marketing manager for present the cost of the cover very early in the buying the company, said of the improved cover: “So many process; the option for customers to include pre- travellers were disrupted by the volcanic ash cloud existing medical conditions, subject to an additional from Iceland in 2010, leaving them stranded and premium; the offer of optional extra cover for winter paying for extra accommodation and living expenses. sports, weddings, golf and business trips; and the We, therefore, felt it was important to make this offer of independent travel cover for customers who extra cover available, providing financial help for have booked their trip through any method other anyone affected by airspace, port or airport closure than a traditional travel agent. as a result of a natural disaster.” The additional cover, Welcoming the new travel insurance product, Rob which can be added to single trip or annual policies, Clarkson, general insurance and external relationships provides cover for cancellation or extra expenses up director at Barclays, said: “We are delighted to to £100 per day. If travellers have to remain at their be enhancing our customer offering in the travel holiday resort, following an enforced stay, or if they insurance market. Our product will be highly price have to make alternative travel arrangements due to competitive and will appeal to a broad customer HSBC teams with Cascade an airport closure, they can claim up to £1,000. base.” He added: “Our standalone travel insurance In further confirmation of the impact of the April product has a number of additional benefits designed insurance providers in Armenia. Garnik Tonoyan, 2010 volcanic ash debacle, another company is to profit our customers. This year, the travel industry HSBC Bank Armenia CJSC and Cascade Insurance chief executive officer of the company, said of the also adding an airspace closure clause to its policies: has faced massive issues, with particular reference ICJSC have announced that a strategic partnership agreement: “This partnership is the first of its kind HSBC and its First Direct division are now including to the volcanic ash cloud, and so it is essential that agreement has been approved by the Central Bank in the financial industry of Armenia. Thanks to this the cover as a standard feature on their policies, Barclays customers have adequate insurance cover.” of Armenia, and the firms can proceed with their type of close business relationship between the following on from the banks’ decision to accept Another major UK insurer, Aviva, will continue to be tie-up. As a result, HSBC Bank Armenia will now be insurance and banking sector, the level and quality claims from customers who were affected by the the insurance provider for the travel insurance that able to sell insurance products such as travel cover, of financial services will see a substantial increase.” ash cloud. Commenting on the improved insurance is inclusive with some of the current bank accounts property insurance, car insurance and personal Astrid Clifford, chief executive officer of HSBC Bank coverage, Brendan Cook, head of HSBC Customer offered by Barclays. accident cover. Armenia, said: “Customers will now be able to go Propositions, said: “In April [2010], we helped Cascade Insurance ICJSC is one of the leading to branches of HSBC Armenia and have both their thousands of our customers who were stranded all banking and insurance over the world. As ‘the world’s local bank’, we felt needs served at one this was appropriate – despite this kind of event not location. We look forward being covered in the standard terms and conditions. Diabetes policy to this co-operation and to We’ve now gone a step further to help our providing excellent services customers in the future – and for more than what launched to our customers.” are hopefully extremely rare events.”

UK-based insurance specialist Insurancewith has launched a bespoke travel insurance policy for people with diabetes. The company is supporting ExploreTrip offers cover the Juvenile Diabetes Research Foundation (JDRF) in its search for a US-based travel website Prasad Gundumogula, chief executive officer of cure for type 1 diabetes, with £1 from ExploreTrip is offering ExploreTrip, said: “[The] Travel Guard travel health each policy sold donated to the charity. customers a broad package plans will include [the company’s] emergency Fiona Macrae, operations director of of travel benefits under assistance services, available 24/7 through [their] Insurancewith, commented: “We are its International Air Ticket global assistance centres. ExploreTrip is committed really delighted to be launching this Program, teaming with to being the comprehensive source for top-quality bespoke travel insurance policy, and Travel Guard to offer international travel services and this affiliation with supporting JDRF through the sale of customers insurance against Travel Guard is another step towards that goal.” He the policies. Our customers are a big unexpected events while added: “The association simplifies the whole process part of how we develop the medical screening at travelling. The travel insurance plans offer cover of buying the best-in-class travel health insurance Insurancewith, which is constantly being updated EasyJet chooses for trip cancellation, emergency medical and health along with cheap flight tickets and discounted hotel and refined. No medical condition is exactly the expenses, travel interruptions and delay, lost baggage bookings in a single session.” same for each individual that has it, and the more insurance over ATOL and more. The policies must be purchased at least customers we screen, the more we are able to tailor 24 hours prior to departing on a trip. our medical screening and make it truly relevant to Low-cost airline easyJet is to financially protect [the] risk.” customers of its holiday venture with Lowcost Travel Group through insurance, rather than through the usual channel, the Air Travel Organiser’s Licence (ATOL) scheme. EasyJet’s chief commercial officer HDFC ERGO Dana Dunne said: “We will offer financial protection through insurance as we do now, and as is perfectly launches product within the Package Travel Regulations. We will provide exactly the same level of protection [as Indian insurer HDFC ERGO has recently launched ATOL] through insurance.” a travel insurance plan, which is a combination of In November last year, easyJet announced a three- convenience and security, according to the company. year deal with accommodation and transfer provider The policy is available to buy online through the Lowcost Travel Group, and together the companies firm’s website, and provides cover against medical are now offering holidays in major markets across emergencies and financial emergencies such Europe through easyJet’s website. as baggage loss, passport loss, flight delays and Dunne added that the company would respond cancellation. Karan Chopra, head of retail business ‘as necessary’ to any changes in ATOL regulations, at HDFC ERGO, said of the company’s decision with the UK’s Department for Transport poised to to make the policy available on the Internet: announce proposals for reform that could create “Customers are finding it convenient to explore a ‘flight plus’ ATOL to cover sales of holidays as details of destinations, flights, hotels and places of separate components. “All we can do is operate interest online, and also to purchase tickets or make within the regulations as they are and follow them if bookings online.” they change,” said Dunne.

International Travel Insurance Journal HEALTHMATTERS 11

CDC WHO: malaria Cholera in Florida offers in retreat Two cases of cholera have been confirmed by health authorities in Florida, US. In both instances, the cases airlines Figures from the World Health Organization involved people who had recently travelled from Haiti (WHO) have shown that worldwide and who have now received treatment for the disease. guidance humanitarian efforts to beat malaria are not in As a result of the cases, though, Floridian officials have vain. In Africa, a total of 11 countries showed put enhanced measures in place to monitor future The US Centers for a greater than 50-per-cent reduction in either outbreaks. Although water, sanitation and food systems Disease Control and confirmed malaria cases or malaria admissions in the US mean that the potential for the disease to Prevention (CDC) has and deaths over the past decade. A decrease spread further is unlikely, it is still possible. issued recommendations of more than 50 per cent in the number of Meanwhile, also in Florida, health authorities have for efforts to reduce the confirmed cases of malaria was also found in reported a case of autochthonous dengue fever spread of the flu virus on 32 of the 56 malaria-endemic countries outside in an urban area of Miami-Dade County, Florida’s commercial aircraft, with a Africa during this same time period, while most populous county. In 2010, a total of 59 cases focus on encouraging airline downward trends of 25 per cent to 50 per of autochthonous dengue were reported, including employees and passengers cent were seen in eight additional countries. 58 in Key West and one in Broward County. At the to get vaccinated; postpone Morocco and Turkmenistan were certified same time, 120 imported cases were recorded, travelling if they are ill; and take normal everyday by the director-general of WHO in 2009 as having including 43 in Miami-Dade. Since 2009, health steps to protect themselves and others while in eliminated malaria. In 2009, the WHO European authorities have noted an increase in the frequency transit. The CDC states that crewmembers onboard Meningitis vaccine Region reported no cases of Plasmodium falciparum of cases of autochthonous dengue occurring in commercial airlines should take several actions if a malaria for the first time. WHO director-general Dr Florida, prompting closer monitoring of the disease. person demonstrates an influenza-like-illness (ILI) hailed Margaret Chan highlighted the transformation that during a flight: keep interaction with the person as is taking place: “The results set out in this report are brief as possible; ask the ill person to wear a face The West African nation of Burkina Faso has become the best seen in decades. After so many years of mask if available, but if not provide tissues and ask the first country to begin a nationwide campaign to deterioration and stagnation in the malaria situation, the person to ensure they cover their mouth while introduce a new meningitis vaccine that promises to countries and their development partners are now on TB test could coughing or sneezing; and, if possible, move the rid the entire region of the primary cause of epidemic the offensive. Current strategies work.” passenger to a seat that is separated from other meningitis. The first vaccine designed specifically for Ray Chambers, the UN secretary-general’s special change treatment passengers, preferably at least six feet away. Africa, MenAfriVac, is expected to help health workers envoy for malaria, commented: “The phenomenal eliminate meningococcal A epidemics in the 25 expansion in access to malaria control interventions is A test that has been developed by the Foundation for countries that form the ‘meningitis belt’, which stretches translating directly into lives saved, as the WHO World Innovative New Diagnostics, along with private firm from Senegal in the West to Ethiopia in the East. malaria report 2010 clearly indicates. The strategic Cepheid and the University of Medicine and Dentistry Seyouda Bouda, minister of health in Burkina Faso, scale-up that is eroding malaria’s influence is a critical of New Jersey that can detect tuberculosis (TB), Swine flu resurgence said: “This historic event signals the beginning of step in the effort to combat poverty-related health including drug-resistant forms of the disease, could the end of a disease that has brought sickness and threats. By maintaining these essential gains, we can revolutionise treatment of the affliction that killed 4,700 The Health Protection Agency in the UK has suffering to generations of Africans. The unique end malaria deaths by 2015.” people every day in 2009. The current diagnostic test confirmed that H1N1 swine flu is the As the WHO’s report shows, strategies to fight for TB has been in use for the past 125 years, and dominant strain of the virus this winter, malaria continue to evolve. Earlier this year, the involves microscopic examination of a sputum sample; and that in December, 10 people in organisation recommended that all suspected cases but it is flawed as it does not easily detect the growing the UK died from the infection. As of malaria be confirmed by a diagnostic test before number of strains of TB that are resistant to antibiotic a result of the deaths, doctors have antimalarial drugs are administered, showing that it is treatment. As a result, some patients have to wait as urged those most at risk, including no longer appropriate to assume that every person long as three months to be diagnosed, which delays expectant mothers and the chronically with a fever has malaria and needs antimalarial treatment and therefore affects recovery prospects. ill, to receive a vaccine. The vaccine treatment. Inexpensive, quality-assured rapid The long wait also increases the chance that the person being offered in the UK protects diagnostic tests are now available that can be used by could infect another unknowingly; or if they are given against three different strains of flu, all healthcare workers, including at peripheral health the wrong sort of antibiotics for the strain of TB they including swine flu. facilities and at the community level. Using these tests have, drug resistance could worsen and spread. In India, state health officials have said improves the quality of care for individual patients, The new test, however, gives results in less than two that two people died from H1N1 cuts down the over-prescribing of artemisinin-based hours. Dr Mario Raviglione, director of the World in Maharashtra in December, with a combination therapies (ACTs) and guards against the Health Organization’s (WHO) Stop TB department, further five people testing positive for spread of resistance to these medicines. said: “This new test represents a milestone for global the infection. In November 2010, However, while progress in reducing the burden of TB diagnosis. We have the scientific evidence, we two swine flu deaths were recorded malaria has been remarkable, resurgences in cases have defined the policy, and now we aim to support and fewer than 10 positive cases were were observed in parts of three African countries implementation for impact in countries.” Trials have identified. (Rwanda, Sao Tome and Principe, and Zambia). The been carried out over 18 months in a number of reasons for these resurgences are not known with different places, with over 8,000 patients undergoing certainty, but illustrate the fragility of malaria control the evaluation. The test, says the WHO, is a fully and the need to maintain intervention coverage even automated nucleic acid amplification test, which is if numbers of cases have been reduced substantially. simple and safe to use. It incorporates modern DNA WHO calls for The report also stressed that while considerable technology that can be used outside of conventional progress has been made, much work remains in order laboratories, although the need for a constant vigilance collaborative effort that has made this breakthrough to attain international targets for malaria control. electricity supply to complete the test could be a possible is both testament to the commitment of barrier to its use in rural areas. The World Health Organization (WHO) is calling ministers of health across Africa and the relentless on countries to be increasingly vigilant in monitoring dedication of our technical partners in developing a antimalarial drug efficacy in order to allow for early vaccine that specifically meets the needs of countries detection of artemisinin resistance, according to the in the African meningitis belt.” conclusions of the Global Report on antimalarial drug Developed by the Meningitis Vaccine Project, which efficacy and drug resistance: 2000-2010. The report is a partnership between the WHO and PATH with is based on 1,100 studies conducted by national support from the Bill and Melinda Gates Foundation, malaria control programmes and research institutes the vaccine provides African health authorities, for the over the 10-year period, and estimates that only 34 first time, with an affordable and long-term solution per cent of malaria-endemic countries are complying that protects even young children against meningitis with WHO recommendations to routinely monitor A. Dr Christopher Elias, president and chief executive the efficacy of such drugs. Dr Pascal Ringwald of officer of PATH, said: “The model created through the Drug Resistance and Containment Unit within the development of this vaccine is groundbreaking the WHO’s Global Malaria Programme, and one and could not have been accomplished without the of the report’s authors, said: “A greater political joint efforts of the African ministers of health and commitment to support and sustain national the many partners and collaborators around the monitoring of the efficacy of antimalarial medicines is world. MenAfriVac may well serve as a model for critical to prevent a wider emergence of artemisinin developing vaccines in the future to combat other resistance.” deadly diseases in low-resource settings.” Myobacterium tuberculosis

www.itij.co.uk 12 TRAVELMATTERS

Travel trends revealed

The results of TripAdvisor’s annual Travel Trends in the travel industry is good news for travel Survey are in, and the news for the British travel insurance companies – 28 per cent of Britons admit industry is overwhelmingly positive, according to the they are more likely to buy travel insurance in 2011 company. “Overall, 2011 looks more positive for than they were in 2010. both travellers and the travel industry,” comments The survey shows that despite government austerity Emma O’Boyle, TripAdvisor spokesperson. “Britons cuts and fears of a double-dip recession, the general intend to travel more often and will spend more mood of the nation when it comes to holiday spend money doing so, but will proceed with caution as the is more positive than a year ago: thirty-six per cent industry emerges slowly from a very difficult year.” of Brits think they’ll spend more on their holidays The Travel Trends Survey reveals that 2011 will see in 2011 than they did in 2010, 32 per cent plan Britons travel more, with a significant number (66 to spend between £2,000 and £4,000 in total on per cent) of people planning to take a long-haul leisure travel in 2011; and an extravagant 14 per holiday. Only a third of Brits are planning a stay-at- cent of Brits intend to spend over £8,000 on travel home holiday next year, marking the possible demise in 2011. of the ‘staycation’ trend, which has dominated in the Security breaches, bomb scares, full body scanners last few years. and inconsistent airport rules have all contributed to Other findings from the survey show that one in travellers feeling increasingly frustrated and confused 10 Britons are planning to travel more on holiday in with air travel over the last 12 months, however. 2011 than they did in 2010: sixty-six per cent of Brits The TripAdvisor 2011 Travel Trends Survey also are planning at least one long-haul holiday in 2011; reveals: just 38 per cent of Brits are planning a staycation in • 14 per cent of Brits have had items confiscated or 2011, compared to 45 per cent in 2010; and over had to re-pack bags at an airport this year; and Thailand counts the cost of troubles two-thirds (67 per cent) are planning at least one • Almost a fifth (17 per cent) of Europeans (14 per domestic holiday, a slight decrease from 73 per cent cent of Brits) admit that confusing baggage rules Prakit Chinamourphong, president of the Thai Hotels Kong or Singapore. The average room rate for a in 2010. will affect their holiday planning in 2011. Association, believes that the country’s tourism five-star hotel in Thailand is around US$133 per O’Boyle said: “The devastating earthquakes in China, “Although, economically, British travellers are more industry is losing its competitiveness to Hong Kong night, compared to $200 in either Hong Kong or Haiti and Indonesia this year have had an impact on confident for the year ahead, it’s still been a turbulent and Singapore, despite offering cheaper products Singapore, yet occupancy in those two destinations is and accommodation, saying: “Thai tourism has averaging around 72 per cent. not recovered from the global economic crisis To worsen the situation further, domestic flooding that started in late 2009 and domestic political in many parts of the country has affected the uncertainty. Foreign tourists are not returning yet, movements of locals. Chinamourphong said, though, so tourism operators must focus more on the “The flooding impact will be short-lived. It’s the domestic market instead. They’re pinning their political uncertainty that will remain the biggest hopes on the coming high season, but reservations threat for the tourism industry, as we don’t know are not as high as they expected.” Chinamourphong how long the state of emergency will go on in many said that average hotel occupancy in 2010 stood at locations.” The UK’s Foreign and Commonwealth around 60 per cent, which was similar to the rate Office has maintained its warning to travellers about seen in 2009; however, it was hoped that the figure certain parts of the country, including advising against would be higher as average room rates in Thailand all travel to Preah Vihear and against all but essential were much lower than those seen in either Hong travel to Pattani, Yala, Narathiwat and Songkhla.

HK maintains popularity

The Hong Kong Tourism Board has estimated that downturn. 34 million tourists visited Hong Kong in 2010. In Jason Shum, a committee member of the Hong September, the tourism board recorded 26 million Kong Association of Travel Agents, said that the visitors, at which time they revised the forecast to number of visitors heading to Hong Kong in the our psyche – but despite a threefold increase from a time for the travel industry, with strikes, volcanic ash 31 million visitors for the year, according to the last few months of 2010 rose significantly because year ago, national disasters affecting travel plans are and airport security issues. With all these aviation South China Morning Post. James Liu, executive of an improving world economy: “We see strong only a concern for six per cent of British travellers.” anxieties it’s perhaps no surprise that environmental director of the Hong Kong Hotels Association, growth of visitors coming from Southeast Asia, such Other issues concerning British travellers this year concerns are now an even lower priority for British said in December: “I guess the annual figures may as Malaysia, Singapore, Thailand and Indonesia, that were identified by the survey include volcanic travellers,” concludes Emma O’Boyle. reach 34 million at the end of [2010].” Lu went on because the appreciation of their currencies boosted ash – 15 per cent of Brits admit they are worried Richard Bray, spokesman for online travel firm to say that hotel occupancy rates averaged around their purchasing power when visiting Hong Kong.” about this disrupting their 2011 travel plans; a third Travelmatch, also commented on the research: 85 per cent between January and September The Tourism Board said that the number of visitors (31 per cent) are fearful of further strikes affecting “The results of the Travel Trends Survey make for 2010, compared with 74 per cent for the first had been boosted thanks to the number of tourists their travel plans; concerns over rises in air passenger very positive reading for everyone involved in the nine months of 2009, when Hong Kong was still coming from mainland China, particularly from the duty, the air travel tax, are likely to affect the travel holiday industry, because they show that a much suffering from the effects of the global economic border city of Shenzhen. plans of over a quarter (28 per cent) of Brits; and higher number of British holidaymakers are intending following the recent high-profile collapses of travel to travel over the next 12 months. As we all know, firms, including Goldtrail and Kiss Flights, over a 2010 was a particularly difficult year for holiday quarter (26 per cent) are worried about travel companies and travellers, so this news couldn’t have companies going bust. However, all this uncertainty come at a better time.”

Sharks prompt drop

Nadezhda Nazina, the Russian deputy minister the beaches around Sharm el-Sheikh were opened of sports and tourism, told reporters that Russian to a degree, with restrictions in place as to how deep tourism to Egypt fell by 20 per cent in the wake of people are allowed to swim, patrol boats keeping a several shark attacks in the popular resort of Sharm lookout for sharks, and coastguards with binoculars el-Sheikh. Nazina was quoting statistics from the trained to search for telltale fins. Federation of the Russian Tourism Industry, which Helmy Bedir, adviser to the Egyptian minister of show the immediate and detrimental effect the tourism, announced during a joint press conference shark attacks had on tourism in Egypt, a country that with an Egyptian delegation that arrived in Moscow relies heavily on tourist dollars. Nazina added: “The in December that the Egyptian government would sooner the Egyptian side settles the problem and pay US$50,000 in compensation to the Russian provides security at its beaches, the less tourists will tourists who were injured by separate shark attacks refrain from trips to Egypt.” Not long after she spoke, in Sharm el-Sheik.

International Travel Insurance Journal TRAVELMATTERS 13

Airline capacity rises The future looks

According to December’s OAG Frequency and bright Capacity Trend Statistics (FACTS) report, global airline capacity was positive in the final month of 2010, with The latest figures from the UK’s Office of National a six-per-cent increase in the total number of seats. Statistics (ONS) have brought the travel industry Worldwide, there were 311.7 million scheduled some good news for the New Year, reporting that seats available in December. Over the last 20 from July to the end of September last year, the years, the number of available seats worldwide has number of Brits taking business visits abroad rose by increased by 40 per cent, growing most years, and six per cent compared to the same period a year the number of flights has increased by 24 per cent earlier. Meanwhile, the number of business visits to during that same period. the UK has also increased by six per cent, showing Peter von Moltke, chief executive officer of UBM that perhaps the green shoots of recovery have Aviation, commented on the report’s findings: arrived. The ONS statistics show that on the leisure “Passenger confidence is growing, along with the side, the number of holiday visits to the UK has also economy, and while some regions’ growth, like the risen by around six per cent; however, the number Americas and Europe, are mirroring the modest of Britons leaving the country for a holiday has improvements in the economic environment, many fallen by three per cent. The three-per-cent rate of are growing at a striking pace. Africa, the Asia Pacific decline, though, is much slower than had been seen and the Middle East all continue to show a large in previous months. appetite for air travel.” During the 12 months from October 2009 to The FACTS report shows that regional increases over October 2010, the number of visits to the UK by the past decade include a 130-per-cent increase in overseas residents was broadly the same as the 12 capacity and a 140-per-cent increase in frequency months before, although over the same period the in travel to and from Africa; and increases of 176 number of visits abroad by UK residents fell by eight per cent in capacity, and 188 per cent in frequency per cent. Comparing the same periods, visits to the in travel to and from the Middle East. Meanwhile, UK by residents of Europe remained broadly the travel to and Top 10 revealed from Asia British Airways has announced that the US, Caribbean crucial focus for us, so growing our holidays business is Pacific countries and Indian Ocean all feature heavily in its top 10 a major part of our business plan. We’ve already made increased by destinations for 2011, but pride of place goes to great progress thanks to the launch of our Dynamic 88 per cent in Marrakech in Morocco. Willie Walsh, chief executive Packaging capability, which enables customers to capacity and officer of the airline, said: “The response we’ve had book flights and hotels together and realise substantial 109 per cent to the launch of routes like the Maldives, Las Vegas savings. Revenue [in 2010] is up 55 per cent and there in frequency. and Marrakech has been incredible. We’ve seen remains a huge opportunity for future growth.” Although destinations in the Caribbean and Indian Ocean The airline’s top 10 destinations for 2011 also include Europe’s becoming even more popular with leisure travellers Tokyo, Puerto Rico and San Diego. Marrakech took growth during looking for sun and relaxation. Those after 24-hour the top spot, followed by San Diego, New York, St the past decade cities are heading towards New York, Las Vegas and Kitts & Nevis, Puerto Rico, the Maldives, Japan, Las isn’t quite as Japan.” He added: “Tourism and leisure travel is a Vegas, Mauritius and St Lucia. impressive as other regions of the world, it is still strong – seat capacity and frequency to and from Europe were robust in December 2010, both increasing by 11 per cent on the same period a year earlier. The report states: “Recent incremental same at 22 million, while those from North America improvements in the global economy are having a fell by five per cent to 3.3 million. Visits from other noticeable impact on passenger demand for travel parts of the world, meanwhile, increased by two per with positive growth in all regions of the world, with cent to 4.3 million. The ONS figures also show that the exception of travel to and from the Americas. visits by UK residents to Europe fell by eight per cent Double-digit increases were also experienced in to 43 million, while those to North America fell by capacity to and from Africa, Asia and Middle East.” nine per cent to 3.4 million and visits to other parts John Grant, senior vice president of airport strategy of the world fell by two per cent to 8.9 million. and marketing for ASM Ltd, sounded a note of Roger Smith, head of the International Passenger Survey caution for the industry: “While load factors and fares for the ONS, commented on the findings: “It does have remained relatively strong in the economic appear that there are signs that the large falls we have recovery process, it is hoped that airlines continue to seen in the recent past have begun to stabilise and add capacity strategically and with prudence in mind, show some signs of recovery. Business visits in both with fuel prices likely to rise [in 2011] and other directions have picked up recently. October saw a recessionary factors impacting the industry, demand small rise in holiday visits both to and from the UK for air travel could be severely tested.” compared with the same month a year earlier.”

AA, BA and Iberia tie up

Three of the world’s biggest airlines have agreed to new routes being launched, along with improved co-operate commercially on flights between Europe frequent flier benefits and the employment of and North America, following more than 10 years hundreds of flight crew. of discussions. The move by American Airlines (AA), Willie Walsh, chief executive of BA, said: “This puts British Airways (BA) and Iberia, all of which belong us back on a level playing field with the other two to the Oneworld airline alliance, will result in several major alliances [Star and SkyTeam].”

www.itij.co.uk ITICamericas-120-dps-final.pdf 21/12/10 13:16:09

2011 ITIC AMERICAS AGENDA

Monday 21st Feb - Day 1 Morning Golf (optional and to be con rmed) Lunchtime Registration and networking buet 14:00-15:30 Healthcare Reform - how it will change the industry? will there be an impact on foreign payers and medical tourism? what are the e ects on cost containment and cost shifting? Panellist 1: Alex Sanchez, Vice President - American Association of Medical Audit Specialists/ Managing Director - Healthcare Concierge Services, Inc. Panellist 2: Ralph Lawson, CFO - Baptist Health South Florida, Inc. Panellist 3: tba Coee break 15:45-17:00 Medical Tourism - crossing borders into South America or the Caribbean; what are the myths? 2011 what is the reality? Update on policies available for medical travellers, medical infrastructure and compentancy of surgeons in these regions. Panellist 1: Lisa Biechl, President & CEO - Transparent Borders LLC Panellist 2: Jim Krampen, Co-Founder, Principal & Executive Ocer - Seven Corners Panellist 3: Mike Torino, VP Business Development - Costa Rica M.D 18:00 Welcome cocktails

Tuesday 22nd February - Day 2

C 10:00-11:45 Air Ambulance repatriation challenges

M Panellist 1: Anne Rodenburg, International Relations Manager - USMX Airlink Air Ambulance Y Panellist 2: Jacob Bercovici, General Manager - Aero Jet International Air Ambulance CM Panellist 3: Alejandro Sanchis, Network Provider Manager - HAA/AXA Assistance

MY

CY Coee break CMY 11:45-13:00 Insurance sales and distribution – impact of uniform licensing legislation for sales of K travel insurance. 13:00-14:30 Lunch 14:30-15.00 Growth of the Latin Market, in and out bound For full details & registration please visit Speaker: Ignacio Marquez, Sales Director - Assist Card www.itic.org.uk/miami 15:00-15:30 Forecasting the future economic state Coee break 16:00-17:30 Mistakes, Mishaps & Consequences: Indemni cation Lawyers discuss what happens when a case involving medical assistance goes wrong. Do credentialing, insurance, indemnication and contractual provisions protect fairly or fail to protect assistance companies and their service providers and vendors? Panellist 1: Tom Hudson, Senior VP & General Counsel - Medex Panellist 2: tba Panellist 3: tba

Wednesday 23rd February - Day 3 10:00-11:30 Hospital cost containment – do doctors really understand travel insurance? Panellist 1: Milan Korcok - ITIJ North American Correspondent Panellist 2: Dr Jose Quesada, Director of Finance & Operations - UHealth International Panellist 3: Sandro Bacchelli, MD, Interntional Patient Care - Clinique Soliel, Hollywood 11:30-12:00 Session details to be announced 14:00 Free time and/or optional focus groups 19:00 Farewell dinner ITICamericas-120-dps-final.pdf 21/12/10 13:16:09

2011 ITIC AMERICAS AGENDA

Monday 21st Feb - Day 1 Morning Golf (optional and to be con rmed) Lunchtime Registration and networking buet 14:00-15:30 Healthcare Reform - how it will change the industry? will there be an impact on foreign payers and medical tourism? what are the e ects on cost containment and cost shifting? Panellist 1: Alex Sanchez, Vice President - American Association of Medical Audit Specialists/ Managing Director - Healthcare Concierge Services, Inc. Panellist 2: Ralph Lawson, CFO - Baptist Health South Florida, Inc. Panellist 3: tba Coee break 15:45-17:00 Medical Tourism - crossing borders into South America or the Caribbean; what are the myths? 2011 what is the reality? Update on policies available for medical travellers, medical infrastructure and compentancy of surgeons in these regions. Panellist 1: Lisa Biechl, President & CEO - Transparent Borders LLC Panellist 2: Jim Krampen, Co-Founder, Principal & Executive Ocer - Seven Corners Panellist 3: Mike Torino, VP Business Development - Costa Rica M.D 18:00 Welcome cocktails

Tuesday 22nd February - Day 2

C 10:00-11:45 Air Ambulance repatriation challenges

M Panellist 1: Anne Rodenburg, International Relations Manager - USMX Airlink Air Ambulance Y Panellist 2: Jacob Bercovici, General Manager - Aero Jet International Air Ambulance CM Panellist 3: Alejandro Sanchis, Network Provider Manager - HAA/AXA Assistance

MY

CY Coee break CMY 11:45-13:00 Insurance sales and distribution – impact of uniform licensing legislation for sales of K travel insurance. 13:00-14:30 Lunch 14:30-15.00 Growth of the Latin Market, in and out bound For full details & registration please visit Speaker: Ignacio Marquez, Sales Director - Assist Card www.itic.org.uk/miami 15:00-15:30 Forecasting the future economic state Coee break 16:00-17:30 Mistakes, Mishaps & Consequences: Indemni cation Lawyers discuss what happens when a case involving medical assistance goes wrong. Do credentialing, insurance, indemnication and contractual provisions protect fairly or fail to protect assistance companies and their service providers and vendors? Panellist 1: Tom Hudson, Senior VP & General Counsel - Medex Panellist 2: tba Panellist 3: tba

Wednesday 23rd February - Day 3 10:00-11:30 Hospital cost containment – do doctors really understand travel insurance? Panellist 1: Milan Korcok - ITIJ North American Correspondent Panellist 2: Dr Jose Quesada, Director of Finance & Operations - UHealth International Panellist 3: Sandro Bacchelli, MD, Interntional Patient Care - Clinique Soliel, Hollywood 11:30-12:00 Session details to be announced 14:00 Free time and/or optional focus groups 19:00 Farewell dinner 16 IPMI NEWS

Aetna names AGB recognised SimpleCare teams with IMC

Mathias as CIO Aetna Global Benefits (AGB), the international International healthcare provider business segment of US health insurer Aetna, has SimpleCare has announced a new US health insurer Aetna has announced the won the International Benefits Provider of the partnership with International Medical appointment of Michael Year category at the Centers (IMC) to open state-of-the-art Mathias as vice-president Expatriate Management medical clinics throughout Spain, giving and chief information and Mobility Awards SimpleCare members in-network access to officer (CIO), reporting to (EMMAs), which were IMC physicians and specialists at discounted executive vice-president held recently in New York rates. A new IMC medical centre in Meg McCarthy. She said City. AGB provides tools, Torremolinos will open in April 2011, of the appointment: programmes and services and will provide radiology services, stat “Aetna recognises that the to help its more than laboratory, day hospital, paediatrics, urology, landscape of healthcare 400,000 members access cardiology and traumatology services, is changing and that high-quality healthcare among many other services. There will also technology will play an around the world and be online consultations available for those ever-increasing role in the helps them to make unable to travel and who have an Internet future. Michael Mathias informed decisions about connection. is highly regarded in the their care. Angel Giro, one of the doctors for IMC, industry for his strong Donna Otten, head of said: “This national agreement with technical knowledge AGB, said the company SimpleCare will allow even more people and he has the skills and was ‘honoured’ by the to experience International Medical healthcare experience to recognition. She added: Centers. Our members tell us they come lead Aetna Information “As we continue to to SimpleCare for our team approach to Services going forward.” expand our presence in healthcare, our affordable health schemes As CIO, Mathias will the global marketplace, and the peace of mind knowing that they have oversight of Aetna we not only want to receive care from many leading experts in Information Services ensure our expatriate their fields. We welcome the opportunity delivery, strategy, members have to collaborate with International Medical operations, technology comprehensive benefits Center’s commercial plan of opening quality and architecture and will Michael Mathias as they move around the medical centres throughout Spain.” be charged with leading globe, but we want to R. Prats, medical director for SimpleCare Health at affordable rates. Obviously we are very excited innovation efforts and implementing the company’s help them live healthier lives.” Plan, also commented on the partnership: “We about providing medical care to the Torremolinos, long-term technology strategy. Since 2008, Mathias The EMMAs were developed by The Forum for look forward to working together and opening new Benalmadena and Fuengirola community along with has served as Aetna’s chief technology officer and Expatriate Management to recognise excellence in centres, giving [our] members and expatriates in our SimpleCare members, but we are not satisfied was head of AIS Enterprise and Architecture from global mobility in 14 different categories of distinction. Spain access to the outstanding services provided and have begun looking at Malaga Capital and Nerja 2006 to 2008. In these roles, he was responsible In 2010, more than 240 entries were received, by the physicians and specialists associated with IMC as future locations to open IMC clinics.” for aligning the firm’s technology vision with business and the independent judging panel that decided the strategy by integrating company processes with the winners included representatives from Unilever, appropriate technologies. Mercer and Ernst & Young. Existing illness covered

Bupa International has launched a health insurance not provide the treatment they need.” He added: policy for expatriates with existing illnesses, which, “We’ve now added cover for pre-existing conditions until now, had been excluded. Customers can as an option for customers purchasing our newest apply for cover for over 60 common illnesses they individual health insurance product, Bupa Worldwide may have already suffered from, including cancer, Health Options. People now have the added hypertension and asthma, as well as acne, high reassurance of knowing that they could be covered cholesterol, hayfever and kidney stones. for a wide range of existing illnesses they have Dr Sneh Khemka, medical director for the previously suffered from.” international private medical insurer, commented on the launch of the new policy: “Until now, it has been difficult to obtain health insurance cover for cancer and other illnesses if you have had them in the past. This is particularly difficult for expats who are in an unfamiliar health system that may

AXA PPP appointments

International private medical insurer AXA PPP developing new marketplaces. Meanwhile, Kevin International has made two senior appointments Melton has been appointed as the firm’s sales in its sales and distribution department. Chris director. Having served most recently as deputy Knott, formerly sales and marketing director for director of market development at Vanbreda the company, has been named as distribution International, in his new role Kevin will be director, with responsibility for growing AXA responsible for developing AXA PPP’s global PPP’s established partnership businesses and expatriate proposition.

International Travel Insurance Journal IPMI NEWS 17

Cancer care introduced

International private The new Elite plan also benefits from increased least cope with them.” He added: “The Elite plan now medical insurer InterGlobal limits for complementary medicine, new cover for strips away all terminal and chronic benefit lifetime limits has introduced its annual dental checkups and the addition of cover for and provides cover for treatment in full up to the annual UltraCare Elite Plan for psychotherapy treatment. benefit limit of £2 million.” 2011, which has a number Paul Weigall, head of sales and marketing for In addition, InterGlobal has simplified and rewritten all of additional benefits, InterGlobal, said of the changes to the product: “The its documentation using plain English to make its plans including enhanced treatment of cancer has improved dramatically in recent easier to understand and clear to customers. This benefits for cancer care. years with many people now cured or surviving far includes a clear description of the cancer care benefits The 2011 Elite plan longer once their condition has become chronic. Many available to members of all the company’s plans. Weigall includes payment for all international private medical plans impose lifetime said: “Delivering high standards of customer service cancer treatment up to the benefit limits for the treatment of chronic or terminal is part of our DNA. We wanted to take this service member’s annual benefit cancer conditions [and] these limits can sometimes philosophy right through our customers’ experience of limit of £2 million, US$3.4 be reached in the treatment of chronic cancer, leaving being a member, including making our documentation million or c3 million. members exposed to medical bills when they could as easy to read and accessible as possible.”

OFT considers private health insurance Britain’s Office of Fair Trading (OFT) has launched an inquiry into private healthcare businesses after a complaint was made indicating that the market is not competitive enough. Insurers and large hospital groups such as Bupa, which operate closed networks in the UK, are the target of the complaint from Circle, one of the Europe’s largest healthcare partnerships. The OFT has said that it has conducted an initial inquiry and must now decided whether or not to continue with a full investigation. Circle has argued that the agreements made between the larger private hospital providers and health insurers including AXA PPP and Aviva are anti- competitive. Collectively, Bupa, AXA PPP and Aviva have a 75-per-cent share of the UK’s private medical marketplace. Ali Parsa of Circle believes that network agreements tying patients to certain hospitals prevent new entrants to the UK’s lucrative private healthcare market, adding: “Let patients choose which hospital they want to go to. Our costs are lower than hospitals we compete with.” She continued: “If you are a National Health Service patient you can go to any facility you wish to go to. If you are a private health insurance patient you do not have that choice.” David Castlin of National Friendly agrees: “When thinking about their healthcare, customers choose private medical insurance because they want choice. Limiting these options to a certain group of hospitals goes against this concept.” A separate complaint about private medical insurance providers was made earlier this year by the Federation of Independent Practitioners Organisation (FIPO). The organisation has argued that restrictions placed by insurers on which medical professionals customers are allowed to use result in a prevention, restriction and distortion of competition in the UK marketplace. Two years ago, FIPO made a similar complaint to the OFT that was not taken any further, but it feels that new restrictions on insurance policies warrant a fresh investigation.

www.itij.co.uk 18 CROSS BORDER CARE

Singapore sees strong competition

According to the latest research from consulting on the figures: “We have to remember that there firm Frost & Sullivan, Singapore’s medical tourism are different business models in operation, with business is growing more slowly than neighbouring Singapore focusing more on quality rather than countries such as Korea, Taiwan and Malaysia volume as in Thailand and India. This is best seen as competition between the nations for medical when comparing the revenue per patient figures, tourists intensifies. Frost & Sullivan’s figures show with Singapore the undisputed leader.” that Singapore attracted 665,380 foreign patients in Foreign patients in Singapore generated US$1.4 2009 – an increase of just three per cent on 2008, billion in revenue in 2009, equating to $2,111 a although Dr Pawel Suwinski, one of the researchers, head, which is higher than any of the aforementioned has estimated that the island city will see 725,264 countries. However, India is closing the gap, with foreign patients in 2010, with annual growth in projected revenue per patient of around $2,100. 2011 and 2012 being nine per cent. All the figures According to the research, 2010 will be the year that are significantly lower than the 15 to 30-per-cent India overtakes Singapore in terms of numbers of growth that Malaysia, Thailand and South Korea are patients, catering to an estimated 731,400 foreign all enjoying, but the higher prices in Singapore mean patients. Despite its political woes, Thailand has more revenue per patient. Dr Suwinksi commented consistently been at the top of the list in terms of patient volume, with Frost & Sullivan estimating that Thailand received over 1.2 million medical tourists in 2009 and will see 1.5 million in 2010. Malaysia outlook is Frost & Sullivan’s researchers Superbug detected believe that the high revenue per positive foreign patient in India is largely in Denmark as a result of outsourcing. An According to the latest report from RNCOS, a arrangement between India’s Denmark has become the latest country to report market research firm, Malaysia is one of the most Apollo Hospitals and US insurer a case of a deadly superbug that is sweeping the popular tourist destinations in the ASEAN region, Blue Cross Blue Shield allows world. According to reports from the country’s and despite the global economic slowdown, it Apollo to treat the insurer’s media, a 57-year-old woman contracted New received around 24 million international visitors in corporate clients, who are usually Delhi matallo-beta-lactamese-1 (NDM-1) while she 2009, an increase of around seven per cent on the high-value patients. Dr Suwinksi was hospitalised in Bosnia-Herzegovina for blood previous year. RNCOS states that Malaysia offers added: “Hospitals in India are poisoning. The virus, which is resistant to almost some of the best attributes in terms of healthcare medically equipped to handle all antibiotic treatment, has so far been found in infrastructure and availability of well-skilled medical European and American patients 13 different countries around the world, including professionals; and with the rising number of hospitals during their stay after medical Germany, Australia, Japan, Kenya, Oman, the US, and dental clinics, along with the various medical procedures. The cost and time of Canada, Norway and Sweden. It is thought that course offerings, the country’s image as a preferred travel also becomes an incentive, seven people have died due to the infection. destination for health-related treatments is being with the US and EU relatively Some experts believe the prevalence and spread enhanced. In 2009, Malaysia received around 69 per closer to India than South-East of the infection is due to the increasing number of cent of medical tourists from Indonesia, followed by Asia.” Suwinksi believes that if medical tourists who travel to different countries for Singapore with 12 per cent. medical outsourcing were to healthcare treatment. In particular, people have been RNCOS says: “Our report has analysed each be taken out of the equation, flocking to Asian nations due to low prices and good- dimension of the Malaysian medical tourism industry Singapore would be the regional quality care. The UK has the most reported cases of and has presented current trends and future outlooks leader in medical tourism, but in the bug, with nearly all the British patients thought in a concrete manner. Further growth will be driven order to bolster the industry, should to have contracted the infection while undergoing by the country’s low-cost advantage, booming consider partnerships with Western medical procedures in India or the Balkans. tourism industry, and large inflow of patients from healthcare benefits providers. neighbouring countries such as Indonesia. It is expected that revenue from medical tourism will grow at a combined annual growth rate of around 20 IVF insurance per cent between 2009 and 2012.” The report provides a thorough analysis of US domestic tourism rises launched the current market performance and future outlook for medical tourism players in Malaysia. David Goldstein of US medical tourism agency policy options or launching pilot Sure Insurance Services Limited in the UK has It also acknowledges the fact that Malaysia differs Health Options Worldwide has said that self-funded programmes to test take-up created the first travel insurance policy to be vastly from other destinations in terms of cost, and fully insured employers are becoming more rates. Goldstein said: “This is a dedicated to medical tourists seeking in vitro infrastructure, human resources, patient perceptions, interested in US domestic medical tourism, where big deal because these insurers, fertilisation (IVF) treatment abroad. IVF Travel Shield, competencies, and the level of government support. patients seek cheaper healthcare in neighbouring such as Blue Cross Blue Shield, as the product is called, has been designed to protect states. Goldstein argues that what is keeping patients have always been conservative. both the patient and their travelling companions for in the US, as opposed to travelling overseas where So to see these giants join the the whole trip, and includes cover the savings are substantially trend signifies that we are on for any complications that may occur higher, is the comfort and the cusp of something big in the during IVF treatment, such as ovarian convenience of staying in their healthcare market.” hyper stimulation syndrome. home country: “It’s easier, Devon Herrick of the National An increasing number of British physically and emotionally, Centre for Policy Analysis added: couples are travelling abroad for IVF for someone to travel within “In the US, healthcare providers treatment as the National Health the US and obtain follow-up often charge substantially Service tries to make spending cuts care than it is for them to different prices for medical where it can, and Leila Wilcox, go abroad. By encouraging procedures. This means there founder of the travel insurance domestic medical travel, are opportunities to reduce costs product, said: “Many couples travel employers can reduce by directing insured patients without knowing they have no employee downtime, improve to a hospital across town or protection should something go employee retention and in another state. But health wrong and that their standard travel become more competitive in insurers and employer health policy is void.” The top five global the marketplace.” plans must identify providers countries visited for fertility treatment are According to Health Options offering quality services at lower Spain, Russia, the Czech Republic, the US Worldwide, several health prices and reward enrolees who and India. With British couples, Spain is insurers, including Anthem Blue use them. Provider networks the most popular destination due to short Cross Blue Shield, WellPoint are competing on price for waiting times for egg and sperm donors and UnitedHealth are adding the business of insurers and and English-speaking staff. domestic medial tourism employer health plans.” CROSS BORDER CARE 19

Russians lured to Swiss care

Authorities in Switzerland are encouraging wealthy directly to the healthcare system, additional income concentrating on state-of-the-art procedures that Russian citizens who head to the country for the is generated by tourist activities. Sobhani also said aren’t always available elsewhere. skiing facilities to return for their medical care that there are plans afoot to broaden its campaign to According to Antoine Hubert, managing director of throughout the year. In order to help boost the target medical tourists from the Arabian Gulf, after the Genolier Swiss Medical Network, around five number of medical tourists in Switzerland, potential United Arab Emirates President Khalifa bin Zayed al- per cent of the 12,000 admitted patients last year patients are being given brochures that tell how Nahayan received treatment in August 2010. came from abroad – a ‘much higher’ proportion Vladimir Lenin, founder of the Soviet Union, found Swiss Health, a joint venture between the country’s than was seen five years ago. Hubert said the foreign asylum in the Alpine retreat. There is already a tourism and foreign trade offices, distributed the patients often receive ‘tailor-made solutions’ and in sizeable medical tourism market in the country, brochures at various popular ski resorts, including doing so, generate as much as 15 per cent of the according to Jan Sobhani, director of Swixmed, a Davos, Klosters, St Moritz and Zermatt. Gregor Frei, company’s revenue: “Foreign patients profit from medical tourism agency based in Zurich. He said that head of Swiss Health, believes that ‘there is enormous our wellness offer and hotel services and often come revenue from medical tourism could climb almost potential’ for increasing medical tourism revenues in accompanied with family members, who also stay fivefold to five billion Swiss francs (US$5.2 billion) Switzerland, as unlike the cheaper options offered in at the clinic. Foreign patients generate more income by 2020, and while most of the money would link countries such as India and Thailand, the Swiss are and profit than a Swiss private patient.”

Industry to be worth $100 billion by 2012

A new report from research firm Frost & Sullivan has found that the global medical tourism industry is growing exponentially worldwide, and is set to become a US$100-billion market by 2012. The report shows that the industry is growing at a rate of between 20 per cent and 30 per cent annually, and is bound to continue this growth pattern in the years to come. At the end of 2010, the report showed the medical tourism industry to be worth around $78.5 billion, catering to over three million patients who travel the world to obtain the medical care they require. One of the latent source markets identified by Frost & Sullivan is the Middle East, where it is estimated that around 20 per cent of the world’s healthcare tourists herald from either Gulf or Arab states. Significantly, the report stated that patients from the UAE alone spend around $2 billion on healthcare travel each year, and as a result, many countries that have identified medical tourism as a growth sector are targeting the region to woo guests and patients to their countries. The report highlighted that Europe in general and Germany in particular are popular with medical tourists, and continue to lead the industry, followed in close second by Thailand, then India and Malaysia. It explained: “Boasting an excellent healthcare system, high quality, safe and quick treatment, Germany is considered to be the top destination for patients from all over the world, and particularly from the Middle East, UK and the US. Germany is also an attractive destination for patients from [the UAE], in terms of distance, cost and tourism attractions.” 20 AIRAMBULANCENEWS

RFDS committed to Taking the long way home HF radio

Karyn Paskett, a London, UK-based flight nurse Prepare for the unexpected The Royal Flying Doctor Service of Australia (RFDS) for International SOS, recounts a successful tale We then boarded our flight back to the UK via has said that it is maintaining its commitment to of repatriation and forward thinking Bangkok, Thailand. Unfortunately, by this time, high frequency (HF) radio monitoring and that the there were violent riots in Bangkok, which had service will continue despite public infrastructure A British gentleman was enjoying an extended intensified over the past day. I was concerned and technology changes in two states as part of holiday around Australia when he became unwell about the impact this would have, should the the service’s ongoing commitment to emergency and was subsequently admitted to hospital. On patient’s condition deteriorate and require further communications throughout the country. further investigation, he was diagnosed with a medical attention. Given the political situation, Robert Williams, acting chief executive of the Dr Jon Warwick, David Quayle and Jane Topliss with the new EURAMI RFDS, said: “Despite technology alternatives, the terminal condition and suffered a rapid decline we had proactively built a contingency plan that ‘Special Care’ accreditation presented during ITIC Istanbul in his health. Being far from home is never easy included speaking with a local doctor, identifying AirMed UK HF radio network remains an important back-up when you are not well and this gentleman required a potential hospital for admission and arranging communication system in rural and remote areas, a medicalised flight home to the UK to be with suitable transportation to a secure area should and the RFDS is committed to its monitoring and friends and continue his treatment. the need arise. During the flight, the patient’s ‘Special Care’ use in case of emergencies in all outback regions of Prior to the flight, the patient’s general medical respiratory status remained stable. Australia, 24 hours a day, seven days a week, across condition was investigated to ensure he would However, after a short stop in Bangkok, we were accreditation for all states. People can continue to make contact be fit to fly on such a long journey. Once a full able to board the aircraft again bound for London with the RFDS in case of an emergency via the HF clinical picture was obtained, it was decided a to proceed with the final 12 hours of our journey AirMed UK radio network either directly on RFDS frequencies, nurse escort would be required to administer home. Once again, the oxygen concentrator was or using Selcall numbers on the VKS-737 radio oxygen, assist with mobility and dispense vital in maintaining the patient’s respiratory status Oxford, UK-based AirMed UK (Air Medical Ltd) network.” He recommended that landholders, medication to optimise his comfort throughout throughout the flight. has been awarded the highest level of accreditation workers and tourists in the outback always plan and the flight. Although the patient was stable at the from EURAMI (the European Air Medical Institute). re-check the appropriate HF frequency and system time, his disease was progressing and there was Contingency planning AirMed gained Full Accreditation ‘Special Care’ for its for their nearest RFDS base as part of their safety and a small window of opportunity to perform the While we were making our way home on the final Learjet 35A fleet. emergency plans as there are subtle differences from repatriation. leg of our journey to London – and unbeknownst David Quayle, chief flight nurse, said: “We have state to state. to me – a natural disaster was occurring over always been a great supporter of EURAMI and we The switch to Selcall voice monitoring in Western New medical equipment the skies of the North Sea. An Icelandic volcano felt that now was the right time for us to apply for Australia (WA) and Queensland in October 2010 We recently acquired a fantastic piece of [the infamous Eyjafjallajökull – Ed] was once accreditation knowing that we were more than followed the decision by Telstra to terminate the equipment in the form of a portable oxygen again erupting and a new ash cloud had entered capable of achieving the Special Care status. Our voice-grade dedicated lines that have previously concentrator, which enabled us to administer UK airspace, resulting in the urgent closure of medical department, under the direction of our supported the HF radio network. The RFDS sections oxygen at up to five litres per minute while London’s Heathrow airport. medical director, Dr Jon Warwick, has increased in these states did not believe they could meet the onboard the aircraft. Under normal circumstances, On the ground, our medical and logistics team substantially over the last few years with significant capital costs required to facilitate internal monitoring. oxygen must be ordered from the airline, had been keeping a close eye on the situation investment taking place in terms of equipment, As a result, in WA and Queensland, the RFDS potentially taking up to three days to prepare, and were making contingency arrangements. software, training and personnel. As a result of this has established a formal agreement with VKS-737 causing lengthy delays Unfortunately, and with the Learjet 35As commencing operations, to provide HF radio equipment and telephone in preparation. The Heathrow the proportion of complex intensive care transfers interconnects for any emergency messages broadcast oxygen concentrator remained closed has increased substantially. This year alone, over the HF radio network to the RFDS. allowed us to and the flight approximately 25 per cent of our transfers have been bypass this step and was diverted intensive care and this can only be done successfully commence the to Frankfurt, with the right structure and team in place.” mission sooner than Germany. You AirMed operates a fleet of nine aircraft out of its usually required. can imagine our London Oxford Airport base, including three piston- With the help surprise to arrive engined craft, four Piper Cheyenne turboprops and of my medical in Germany! On two Learjet 35As. and operational learning that our There are two levels of EURAMI accreditation, colleagues, we plane would be said AirMed UK. Full accreditation: an air medical packed the necessary diverted, I was service demonstrates substantial compliance with the medical equipment confident that EURAMI Accreditation Standards. Full Accreditation and completed the necessary is granted for three years. Full Accreditation ‘Special the logistical arrangements Care’: in addition to substantial compliance, the arrangements required would be in place. service demonstrates proven capabilities in air for the mission. We were soon bound for Adelaide, Once again, my colleagues saved the day and had transports of special high-risk patients (for example Australia, which, incidentally, is my home town. proactively arranged an admission and ground IABP, ARDS, neonates, and NO ventilation) providing transfer in Frankfurt if the plane was unable to continued high-level care. Homeward bound for both of us continue to our final destination. Luckily, we were Going into the future, AirMed UK is looking to On arrival in Adelaide, I went to the hospital only grounded for two hours and were able to become fully involved in EURAMI and its new online to assess the patient and meet with his treating continue on the rest of the journey. The patient training Academy. This will go hand in hand with the doctors for an update on his medical condition. remained stable and we finally arrived safely at continued planned investment and growth within

As soon as I arrived, he was extremely pleased Heathrow. the AirMed UK departments, for example medical, An RFDS communications centre RFDS to see me and expressed his gratitude and relief maintenance, flight operations and aircraft fleet. that he would soon be going home to the UK. Home sweet home After discussion with the local doctors, the After arriving back in the UK, I continued to patient and my medical colleagues in London, it use the oxygen concentrator until we were met was confirmed he would be fit to travel and the by the ground ambulance and safely transferred Baghdad injured LAR celebrates mission could proceed. I then headed to the hotel to the patient’s local hospital for admission. for some much-needed rest and relaxation, via my After handing the patient over to receiving care transferred to France mum’s house for a cup of tea and a surprise visit providers, he once again expressed his gratitude Luxembourg Air Rescue (LAR) has welcomed its with my family! and thanks – he wasn’t the only one happy to be 180,000th member, celebrating the milestone with a On the day of departure, I assessed the patient back after such an adventurous journey! French medical teams were responsible for the presentation at Findel Airport. At the same time, LAR again to ensure his condition remained unchanged I returned to the office with a sense of medical evacuation of 36 people who were injured announced plans to move its aircraft to a new hangar and he was safe to transfer. The ground ambulance accomplishment, knowing that we were prepared in the attack on those worshipping in the Sayidat at the same airport and to purchase two new Learjet crew arrived and we proceeded to the Adelaide for any obstacles that came our way. Having the al-Najat Cathedral in Baghdad, Iraq, on 31 October. 45XR planes. airport to board the first flight into Sydney. foresight to pack extra batteries for the oxygen A team of 12 health professionals, lead by the René Closter, president of LAR, said: “[The During the flight, I closely monitored his concentrator was key to the success of this Quai d’Orsay Crisis Centre’s doctor, conducted organisation] could not exist without the support condition and used the oxygen concentrator mission. Being prepared for the unexpected and the operation and provided medical care onboard of its members, who are the reason that LAR to administer the necessary oxygen required at having contingency plans to cover all scenarios are the aircraft, which was charted for the mission by exists. Without this community and the funds from altitude. He tolerated the initial leg of the journey the some of the most important elements of cross- the Ministry of Foreign and European Affairs’ Crisis membership, air assistance to save peoples lives well, and I was happy to continue on the long- border medical movements. There is never a dull Centre through Aigle Azur and Mondial Assistance. could not exist. We are therefore happy to see an haul flight that would take us back to the UK. moment as a flight nurse! All the patients were treated in either civilian or increase in our membership because this allows us to military hospitals in Ile de France. improve the quality of our service.”

International Travel Insurance Journal AIRAMBULANCENEWS 21

Mission to Ascension Island NEWSWIRE Luxembourg Air Rescue reports on a rare mission located halfway between Africa and South America, to Ascension Island, mid-way between Africa and was not possible for any reason, it had to be ensured AGG Aviation, a subsidiary of AGG South America in the Atlantic Ocean that the aircraft would have enough fuel to be able International, has launched the operation of its to fly back to the African mainland. Therefore, a Beech 1900C Medevac Service between Basra, The Luxembourg Air Rescue team flew to Ascension touchdown was scheduled in Monrovia, the capital Iraq, and the new Al Seef Hospital in Kuwait. The Island in the middle of the Atlantic Ocean recently to of Liberia. medevac service will provide oil and gas companies take a 43-year-old British man back home. It turned The medical team arranged for sufficient medications operating in Iraq with emergency 30-minute direct out to be a life-saving mission. and oxygen since none of these were available on flights in and out of Basra, eliminating the lengthy Since early childhood, the 43-year-old patient has Ascension. The Luxembourg Support Centre had and sometimes dangerous land crossing currently LAR been suffering from cerebral palsy, a brain condition clarified all medically relevant facts beforehand; the used in emergencies. that allows him to lead an almost normal life with crew had been informed of the critical condition only a few restrictions, thanks to long-term therapies. and the limited medical facilities on site, but even so Remote Area Medical is recruiting for Providers warned However, the hotel bookkeeper suffered a seizure the situation they encountered on Ascension Island ‘strong men and women’ to help blaze trails on the island as the result of a fall. The pain and was worse than expected. Not even the simplest and build an airstrip in Haiti near the mountain for fixing prices stress triggered by the fall caused the patient to equipment, such as an X-ray unit, was available. The community of Medor. The creation of the roads and completely lose control of his movements, and he patient’s condition was so critical that the medical airstrip will allow for emergency medical evacuations The Commerce Commission of New Zealand had to be immobilised completely for his own safety crew first put him into a medically induced coma in and the movement of medical teams. has formally warned two air ambulance companies and fed through a feeding tube. However, medical the hospital, using the medication they had brought who were competing for air ambulance evacuation treatment on the island is limited. With only around with them, in order to stabilise him and make him The Royal Flying Doctor Service (RFDS) in contracts to New Zealand (NZ), following an 1,100 inhabitants, just two doctors live on Ascension; transportable for the return flight. Tasmania has set up a new simulator for training investigation by the Commission into price fixing. The medical facilities are severely limited and most In the course of the day, the LAR crew was able paramedics for medical flights. Based at Launceston two companies that have been warned are NZ- definitely not geared to handle such a special case. to fly the seriously ill patient to Brize Norton near airport, a mock-up of an RFDS plane interior allows based South Pacific Air Ambulance (now known as The local UK Royal Air Force base, which was called Oxford, UK. Here, the patient could receive crew members to practise providing care in the Maccawat) and Australia-based Careflight. Commerce in first, also does not have the necessary facilities appropriate therapy that had not been possible on confined space of the aircraft. Commission spokeswoman Kate Morrison said on site to fly the patient to the UK in a medically Ascension Island. that the commission had reached an ‘administrative adequate manner. A Liberal party motion calling for the settlement’ with both firms, which included a formal For this reason, Luxembourg Air Rescue (LAR) was Additional information Tasmanian Government to bypass an open tender warning. As part of the settlement, both companies engaged. The flight was planned and the crew was and award a non-contestable contract to the Royal admitted that they had ‘inadvertently breached’ the briefed without delay. Now it was time for LAR’s Located in the middle of the South Atlantic, Flying Doctor Service (RFDS) South Eastern Section Commerce Act by agreeing on a price that CareFlight officers-in-charge to find a stopover as close as Ascension Island is not a typical holiday has been rebuffed. Minister of Health Michelle would quote for an air ambulance evacuation in 2009. possible to Ascension Island – as, if it turned out destination. The island is part of a UK overseas O’Byrne said the move was a call to abandon proper Morisson said that the price fixing was instigated by the at short notice that landing on this island, which is territory together with St Helena and Tristan process. The RFDS section has won the contract on then-managing director of South Pacific air Ambulance, da Cunha. Due to its strategic location midway each occasion it has been tendered since 1994. and that none of its other directors were involved in in the South Atlantic Ocean, the island is or aware of the conduct. currently home to a NASA outpost, a European Global Jetcare has announced plans to go Both companies were credited with co-operating fully Space Agency ‘Ariane’ tracking station, the UK ‘green’, including switching all office and hangar with the investigation, which found that neither one Royal Air Force and the US Air Force, along lights to fluorescent units, moving paperwork onto had a ‘clear understanding of their obligations’ under with a BBC World Service South Atlantic electronic documents and setting up car pooling for the terms and conditions of the Commerce Relay Station, which facilitates intercontinental community employees. The US-based company said Act, in particular where the boundaries communications. the moves came from a commitment to promote a lie for companies that are in competition, LAR greener working environment and to reduce costs. but also subcontract work to each other when necessary. Morisson clarified: “In a Ambulance New Brunswick, Canada, has subcontracting relationship, some pricing Corporate Angel flies 35,000th Patient said it is no longer experiencing difficulty retaining information will be exchanged legitimately, but flight nurses. The provider stated last year that it the parties as competitors must not disclose or Corporate Angel Network (CAN), a US organisation was operated by NetJets, a fractional jet ownership had been challenging to maintain a full roster, as agree the prices they intend to offer the final that arranges free flights to treatment for cancer company whose owners frequently donate flight time crew members must be highly skilled and face a consumer.” patients in the empty seats of corporate aircraft, for transporting Corporate Angel patients. high-stress, travel-filled lifestyle. The situation was made more complex recently announced that it had transported its The milestone followed a busy July for Corporate by the events of 2009, which saw the 35,000th patient. The flight carried patient William Angel, during which 307 patients were carried, the CEGA Air Ambulance, UK, has achieved two companies exploring an acquisition or Relyea, aged 16 months, along with his mother and largest number in any month since CAN began full accreditation from the European Aeromedical buy-out opportunity, and in January 2010 his grandmother, from Westchester County airport to operations. These flights are performed by the 500- Institute (EURAMI). The accreditation includes an CareFlight purchased South Pacific Air his home in Syracuse, New York State. William had plus major corporations who participate in Corporate endorsement of CEGA’s ‘special care’ capabilities. Ambulance’s business and assets. However, been receiving treatment for neuroblastoma, a cancer Angel’s programme and typically involve cross-country until the merger and acquisition was formally of specialised nerve cells, at Memorial Sloan Kettering trips to and from major cancer treatment centres. The government of Malaysia is to set up a completed, said Morisson, the firms were Cancer Center in New York City. He and his mother, The charity has received numerous awards in recognition network of 30 air ambulance helicopters to provide technically still in competition with each other Kristie, were accompanied to the flight line by Dr of its service to cancer patients including the Volunteer aeromedical services to the civilian population. The and therefore could not discuss quotes and/ Wally Hirschberg, an oral surgeon who has served Action Award, the highest volunteer award from the US plan is expected to be implemented by 2015. or prices. for 21 years as a volunteer for the charity. The flight president. The first CAN flight was flown in 1981.

www.itij.co.uk 22 NEWSANALYSIS

Licensing uniformity in the US

The adoption of uniform licensing standards public ‘that there will be more consistent control consumer advocates, unlike the status it has in the and guidelines for travel agents and other over those who sell travel insurance’ and would UK and Europe, where travel insurance is much sellers of travel insurance across the US ‘provide travel agencies with a value-added source travel insurance more of a top-shelf product that consumers and the (as reported in ITIJ 119) sounds like such a of revenue’. media pay attention to. In the US, travel insurance rational move one might wonder why it has often slides under the is one of five ‘core limited lines’ of insurance along taken so long, and why the struggle has been Overcoming limitations with car rental, credit, crop, and surety insurance. so heroic. Milan Korcok has the answers Unlike many countries where such standards In addition to these core limited lines, some states and guidelines are set at a national level and radar of legislators, authorise limited lines licences for many other entities As Jim Grace, president of the US Travel Insurance superimposed over a single administrative entity, the such as pet cover, self-storage, communications Association (UStiA), commented in releasing news regulation of insurance in the US has traditionally regulators and equipment, pre-paid legal, and motor club insurance of the adoption: “We have come a long way, and been scattered over a dog’s breakfast of federal and among others. It should be noted, however, that couldn’t have accomplished this without the help of state jurisdictions, each demanding and scrapping consumer advocates, travel insurance – in respect to these new licensing our members and the support of ASTA (American over a piece of the bone, and each state jealously standards – does not include major medical plans Society of Travel Agents) … (but) we still have a lot guarding its own prerogatives. What this means to unlike the status it has providing comprehensive medical protection for of work ahead, to ensure that each state’s insurance the consumer who works in New York and lives long-term travellers, those working overseas as commission implements these guidelines.” Grace in Connecticut is that he or she can come under in the UK and Europe, expatriates, students living abroad, or deployed was referring to the adoption of new language by the different, and possibly very inconsistent, sets of military personnel. For the record, the NAIC National Association of Insurance Commissioners marketplace rules when buying something as basic as where travel insurance defines travel insurance as ‘including but not limited (NAIC), with the assistance of UStiA and ASTA, travel insurance. to: interruption or cancellation of a trip or event; which will allow travel retailers, including travel Compounding the problem, for the seller as well is much more of a top- loss of baggage or personal effects; damages to agencies and agents, to offer and disseminate travel as the consumer, is that travel insurance is not a accommodations or rental vehicles; sickness, insurance products without a licence so long as ‘major’ line of insurance as are Life, Accident and shelf product accident, disability or death occurring during travel. specified consumer protection requirements are met Health, or Variable Life. Thus, travel insurance often Writing in the 2010 spring issue of the FORC Journal – a move, he said, that would assure the travelling slides under the radar of legislators, regulators and (Federation of Regulatory Council, Inc.), Greg E.

International Travel Insurance Journal

24 NEWSANALYSIS

and ASTA were able to announce that they had applications, receive and record information from ‘achieved a milestone in the quest for adoption of a policyholders to pass on to insurance producers uniform licensing standard for travel agents and other for their response, to schedule appointments sellers of travel insurance’. Yet, as UStiA president with insurance producers to discuss insurance, or Jim Grace emphasised in making the announcement, to conduct other activities on behalf of licensed this was not the end of the road: there was still a producers. But the information, marketing materials, Mitchell, long way to go in implementing the standards and and fulfillment packages they provide must clearly head guidelines across all 50 states and territories, where identify the insurance producer by name and include of the sellers of travel insurance meet day-to-day with their their contact information. The bottom line is that the insurance customers. customer must know who he or she is dealing with regulatory each step of the way. practice Accordingly, licensed producers will have to keep group for the there was still a long way registers of each travel retailer that offers travel legal firm Frost insurance on their behalf, they will be required to Brown Todd, LLC, to go in implementing appoint one of their employees as a Designated noted: “Limited Responsible Producer (DPR) responsible for seeing lines producer the standards and that the producer remains in compliance with the licences run the gamut insurance laws, rules and regulations of the states in among the various guidelines across all 50 which they are doing business, and that they comply states as to the type of with such details as employee background checks insurance products covered states as required by each state. In addition, they will have and the applicable regulatory to ensure that each employee of the travel retailer requirements. Issues with uniformity whose duties include offering and disseminating travel and reciprocity continue to be a source insurance receives of utter confusion to regulators and trade a programme of alike.” He notes that a current review of instruction or training. the NAIC’s state laws reveals 55 different types of limited lines licences available in the Stand up and be various states. In addition to the numbers of counted available limited lines licences, the regulatory Jack Zemp, a tri-chair requirements for issuance of these licences of the UStiA’s law and also vary widely among the states. Thus: regulatory committee, some states may require a travel explains that though agency to have one employee at each almost all states use location in possession of a limited versions of the NAIC lines licence; another state may Producer Licensing require the company and managing Model Act as well as employee to have a limited lines the NAIC Uniform licence; others may not require Resident Licensing a limited lines insurance licence Standards, ‘there where travel-related coverage was inconsistency is offered concurrently with the in the interpretation sale of a travel product; and so of requirements for on. Mitchell explains further that limited lines (including ‘licensing the counter person at a travel)’. He told ITIJ: car rental company, the counter “The new standard person at the self-storage facility, or addresses this the travel agent at a travel agency inconsistency for travel does little to provide consumer insurance (and) … protection when the substantive depending on a state’s issues of regulatory consumer laws and regulations, protection lie with the insurer or it will determine if it the MGA/MGU who developed can adopt the new and distributed the limited lines standard by legislation, product’. regulation or bulletin.” He added that the Milestone reached UStiA and ASTA UStiA, in concert with ASTA, would continue to began working to streamline the work collaboratively licensing process in the spring with regulators to of 2008 within the umbrella promote the adoption of the NAIC, which was of the new standards recasting a new Uniform He noted that currently, each travel agency, travel as soon as practicable: “We anticipate that most Licensing Standard agent, and others selling travel insurance must states will adopt the required change within two and Implementation be licensed in the states where they conduct years,” he said. Guideline for business. But the new NAIC amendments ‘lay As with many financial regulatory issues, the limited lines the groundwork for states to adopt one standard impetus for more transparent licensing was initially insurance licensing approach’, and in those states that adopt the prompted by legislative action. In 1999, a federal producers. It amendments (all are expected to), travel retailers – law was passed requiring states to enact uniform was a tough including travel agencies and agents – will be allowed laws and regulations governing the licensure of pull, but in to offer and disseminate travel insurance products individuals and entities authorised to sell insurance October without a licence as long as specified consumer within their states. In response, NAIC wrote the 2010, protection requirements are met. “By providing one Producer Licensing Model Act to help insurance UStiA set of licensing standards across all 50 states, the producers comply with the federal requirements. travelling public can be assured that there will be The Act, however, was implemented mainly by more consistent control over those who sell travel the six major insurance lines – Life, Accident and insurance,” he added. Health, Property, Casualty, Variable Life and Variable Under the new NAIC Standards and Guidelines, Annuity, and Personal. Limited lines of insurance, in states where the new standards apply, travel such as travel insurance, were largely ignored. agents and other sellers will not be required In 2002, NAIC adopted the Uniform Resident to have a licence to provide brochures and Licensing Standards, which broadened the focus other general information about coverage on licensing beyond the major six, to include the and price, to collect premiums, distribute limited lines of insurance. Now, eight years later, buyers’ guides and applications, process travel insurers are ignored no longer. n

International Travel Insurance Journal International Travel Insurance Conference PACIFIC

Hong- Kong 21-23 June 2011

Conference Meetings Networking Seminars Discussion Forums ITIJ Awards 2010 broc.indd 6 20/10/10 13:36:54 26 FEATURE

Digital Marketing 2

any travel insurer’s online strategy. Only a select internal links pointing to them, and that no individual When it comes to your PPC strategy, the key is In a competitive travel insurance number of keywords that are highly relevant to page is orphaned (stuck without any internal links to develop long tail keywords (in a similar vein to market, insurers can gain all-important the business should be chosen for optimisation. pointing to it). SEO), so that traffic can be bought at a relatively differentiation through established and And, crucially, they should also have the potential Meanwhile, also consider your inbound links. Waiting cheaper rate and achieve a positive return on emerging digital marketing channels – to deliver high traffic volumes. To achieve this, do for people to naturally link to your site can take a investment. Misspellings are also an important part of they just need to be planned, applied proper keyword research – get as much input as long time, so be proactive and have a link-building any keyword strategy – misspelling of the company and tracked effectively. In this second of possible from colleagues, competitor sites, focus strategy to acquire quality links to your site. Also, brand name but also that of various cities and a two-part series on digital marketing, groups and customers. The idea is to get inside your review existing inbound links. Since getting new links countries of the world should be included in your Matt Barker explains how to do just that potential site visitors’ heads and find out what they to your site is quite a task, you should review the keywords. Also key to the PPC strategy is having would type into a search box to find your site pages. existing links that already point to your content, and relevant landing pages for traffic that is being directed The travel insurance market is highly competitive As well as the obvious high-volume terms such as correct any errors, make sure they are not pointing via search engines. If someone searches for ‘travel and insurers are constantly looking for ways to ‘travel insurance’, travel insurers should look at more to dead pages, and even get them to change the insurance Las Vegas’ on Google, when they reach differentiate themselves. Digital marketing – whether specific terms such as ‘travel insurance Europe’ or anchor text to something better than just your URL the destination page they will expect to see copy referring to the more established channels or ‘ travel insurance New York’ – there will be less (Uniform Resource Locator – or a link to your home regarding Las Vegas and to easily be able to get a emerging channels, such as social and mobile – is competition for these terms, meaning a greater page). quote for this trip. an invaluable tool in this process, when applied likelihood of appearing in a top position on Google At the same time, it is important to engage with your An affiliate programme is another important Pull correctly. The good news is that when implementing and other engines. visitors – allowing user interaction and comments channel and if used correctly can drive significant an online marketing strategy, there are some key There are also a number of simple behind-the- on your site not only gives you constantly updated levels of incremental sales. It is important not to rely things to focus on that will make your campaign scenes practices that will help your SEO, such content, it also gives your site visitor greater on two or three big affiliates to drive volume but to much more likely to succeed. The key to any as keeping your site code clean, but one of the connectivity with your site. Obviously, this needs have a good mix of different affiliate types. Cashback online success is to ensure that both ‘Push’ and key elements of successful SEO is links. You need to be monitored, but the benefits of an engaged sites should be approached differently and the quality ‘Pull’ strategies are working together to guarantee to make sure that your internal link structure is audience outweigh the odd negative comment you of the leads and customers generated measured that you are covering all sections of the market. optimised. Search crawlers navigate around your should be acting on. Search engines love updated closely. Push, such as email and offline marketing, which can site through your navigation and internal links, so content on web pages, and this is an easy way to For all of the channels, it is essential to have robust often be overlooked because they are not directly make sure your most important pages have the most achieve higher rankings on a regular basis. tracking systems in place to make sure that you can attributed to driving acquisition, will create the brand clearly see what is working and what isn’t and adjust awareness; and the Pull, such as pay per click (PPC), your strategies accordingly. A proven growth in sales search engine optimisation (SEO) and affiliate, will will also help gain greater budgetary support. work to convert these into sales. In the highly competitive travel insurance Big world, small world Push me, pull me Beyond these more traditional digital market The interesting element of the Pull channels is that marketplace, where a premium is paid for PPCs and channels, it is also worth considering emerging there are some easy-to-follow ways to make sure channels, such as social and mobile, but this shouldn’t that you are getting the most out of them. In the margins are low, it is imperative that SEO is at the mean that you have to get involved straight away. highly competitive travel insurance marketplace, The problem with social media is that a lot of people where a premium is paid for PPCs and margins heart of any travel insurer’s online strategy feel they have to get involved, and jump in without are low, it is imperative that SEO is at the heart of putting a well-thought out strategy in place.

International Travel Insurance Journal FEATURE 27

Social media is far from straight forward; everyone in the right way, can help build that relationship a commission. What’s to say the commission earned wants to do it, but very few do it well and make it of trust between the insurer and their customers. on the referrals Smith makes couldn’t be used to work in terms of driving sales. The key ‘roadblocks’ Not only is it a way of encouraging word-of-mouth fund a night out when they are actually on holiday? that brands come up against when thinking about a recommendations – which when it comes to trust is The challenge here is how you communicate this social media strategy are: one of the most powerful tools – it allows people to offer in the first place – educating him and explaining 1. Internal politics – which internal team will manage have a two-way conversation with insurers as well, how he could benefit from this – and handholding the social strategy – PR, brand, online or category building a relationship and an understanding. him through any affiliate sign-up process. team? What’s more, social media is also a useful tool when Mobile marketing could also be invaluable to insurers 2. Resourcing levels – do you need a dedicated there is a crisis – again, for customer retention – such and they need to find a way to make this work for person/team and what are the escalation as during the British Airways strike. Insurers can them. Often, taking out insurance can seem like a procedures? lengthy process and isn’t a part of the holiday booking 3. Brand protection – will it encourage negativity that many people look forward to; so by introducing towards product/service because of the customer ways of taking out insurance that can be last-minute freedom and open platform? or quickly sorted, via mobile for example, so much The problem with social the better. Offering a last-minute deal at the airport If considering putting together a social media strategy, to those who have forgotten to buy travel insurance it is still essential to agree what you want to achieve. media is that a lot – that can be agreed via their mobile phone – would Recent research from Celent published in last be a good starting place. month’s ITIJ shows that while 59 per cent of insurers people feel they have But, due to the regulations of the insurance industry, believe that ‘social’ marketing is an effective way of there is a balance that needs to be struck between achieving company goals, this is not reflected in their to get involved, and making sure people understand the terms and budgets. The reason is often because those on the conditions of their cover and making it quick and ground can see the benefits but have not got the jump in without putting easy for people to buy it. And again, this is where right parameters in place to prove its worth to those the issue of trust rears its ugly head. So, before the who hold the purse strings. a well-thought out insurance industry can move confidently into the It is important to note that social marketing is very mobile world, there is a need to build a level of trust much a retention tool, not an acquisitions function. strategy in place with consumers, which is where social media could It still has a vital role to play in the overall marketing come into play. mix, but more as a brand communication tool. As Both traditional digital marketing and emerging a result, monitoring the success of social is very marketing channels present the travel insurance industry different to the hard figures that you often get with get advice to their customers quickly, positioning with real opportunities to differentiate themselves in a other channels, but that does not mean that goals themselves as a useful source of information and competitive market. But it does not pay to just jump and objectives cannot be set, especially when it support. This all does have to be handled carefully in. Yes, digital marketing, whether it is traditional or via comes to retention. and reactions need to be quick, otherwise it will only an emerging channel, should be a central part of the What’s more, any brands that offer a service to add to the consumers’ frustration. Again, tracking marketing mix, but it needs to be carefully considered, potential consumers have to be prepared for sentiment is essential here. your objectives clearly identified and results accurately negativity on the social forums. The key to success For more measurable sales figures, there is tracked; otherwise any investment – both time and with social media is to be able to turn that negativity the opportunity to expand on the traditional financial – will be wasted. n around via a proactive, scalable management process ‘recommend a friend’ bonus scheme via social that will ensure that you are actively seen to be media. Again, the way that this is approached is key dealing with issues on a one-to-one basis. This can and it needs to be done in a way that will appeal – it Matt Barker only truly be delivered if you are tracking ‘sentiment’ should be fun and interactive and created so that started his career over the forums using a robust tracking solution. those who get involved won’t lose credibility with in traditional In fact, social media is a useful tool when it comes their friends. For example, let’s say Traveller Smith media planning to reputation management and relationship building. is booking a holiday for him and his mates and but was frustrated One of the key benefits of social marketing is that it arranging it on Facebook. Smith could be encouraged by the lack of can help with one of the main issues in the insurance to sign up to an affiliate network when he buys his accountability world – trust. In fact, according to a Mintel report insurance. He would then use his unique link for and saw newly published last year, one in three people says they his chosen travel insurance company so he could emerging online don’t trust insurers to pay out when needed, and direct traffic to their site by including the link in his channels as being the issue of cover is one that needs to be addressed Facebook post – whenever someone buys through a real opportunity by insurers across the board. Social media, if used that link he would be credited with the sale and earn for innovation. Over the past 10 years, Matt has worked for a number of high-profile clients, encompassing all streams of online marketing. During this time, he co-founded Stream:20, a leading digital marketing consultancy, which now counts Sky, National Express, EMI and Betfair amongst its clients.

www.itij.co.uk 28 FEATURE

Trauma on the slopes

As skiers in the southern hemisphere hang up predict the injury patterns. However, sometimes all coalesce into what we can all do to make the ski injury can create increased debilitation and lengthen their boots, in the northern hemisphere skis and the injuries are severe and complex – but we can industry safer. rehabilitation. We typically see lower extremity boards are being waxed and snowsuits donned in still predict the injury pattern. Knowing these injury Even though we, as air medical providers, typically injuries in skiers and upper extremity injuries in preparation for the season ahead. Brett Henyon patterns, understanding the things we can do to see the most severe injuries, we need to be sure snowboarders. Many resorts are also adding tubing discusses points to consider when airlifting injured mitigate these injuries as an industry, and predicting we look for the less severe injuries in certain hills, bike parks, and other specialised ski boards – skiers from the slopes transport considerations for the air medical industry patient populations. An overlooked or missed although statistical data on these patterns is limited, based on simple kinematics we can suspect isolated Can you imagine what the inside of your helicopter head and upper torso injuries. would look like if you cut into a down-filled skiing jacket to expose and treat your patient in flight? How about the untoward harm created by a missed open fracture of an extremity that is now pulseless in the trauma bay? Ski sport injuries are unique in the aspect that there are often complicating factors with identification, extrication, and transport. The kinematics of trauma are very clear and the sport has inherent dangers. There are many ways to mitigate the risks of participating in these types of winter sports, but invariably injuries will occur. Often these injuries are minor and we can often

International Travel Insurance Journal FEATURE 29

Jordi Boix

to falls. The most common lower extremity knee. With this injury pattern, the uphill arm is back, injury involves the knee with damage to the the skier is off balance to the rear, hips are below medial collateral ligament (20 to 25 per cent of all the knees, bodyweight is on the inside edge of the injuries) and is typically seen in beginners or lower downhill ski tail, the uphill ski is unweighted, and intermediate skiers. A valgus load is applied to the the upper body is facing the downhill ski. Distal knee joint as a result of the fall, skis crossing or the tibia and fibula fractures are common boot-top ‘snowplough’ stance widening. Anterior cruciate fracture patterns for skiers. Additionally, complex ligament injuries account for 10 to 15 per cent of femur fractures can be associated with improper all ski injuries as a result of the ‘phantom foot fall’, binding settings resulting in a twisting segmental where the tail of the downhill ski and the stiff back femur fracture and supracondylar femur fractures, of the ski boot act as a lever to apply a bending especially with older patients or those with some Annual statistics of injury patterns remain consistent sometimes, due to the complexity of additional life and twisting force across the knee of the downhill form of degenerative bone disease. Mid-shaft femur – even with rapidly evolving ski safety equipment threatening injuries, they can be missed during the such as improved binding release technology, initial treatment phase. helmet education campaigns, and overall safety education programmes. For alpine skiers and alpine Common injuries snowboarders, sometimes these orthopaedic injuries For alpine skiers, sprains and strains of the lower can be so severe they are not overlooked. But limb still account for over half of the injuries related

Matthias Zepper www.itij.co.uk 30 FEATURE

Krzystof Ibrandt fractures are the most common femur injury seen and the secondary assessment and treatment. Often the initial responders have exposed/assessed and in the ski industry, and packaging considerations are in the air medical setting, the patients will go directly consideration for wet, cold, hypothermic patients is paramount to the air medical industry. If the traction from the on-the-hill treatment and packaging directly a must. It is paramount to suspect certain injuries, Insulation explosion splint extends too far, loading into the helicopter can to a waiting helicopter. Consideration for what anticipate certain transport challenges, and be ready become complicated or often impossible without Treating injured skiers often means dealing releasing traction and adjusting the splint. Another with ski clothing insulated with fibres or down not-so-common injury that can complicate helicopter (feathers). Author Brett Henyon suggests loading is a posterior hip dislocation. that, where possible, down jackets should For snowboarders, over half of the injuries are be removed before the flight, as cutting into related to the upper limb. The most common injury clothing in the helicopter can result in a large patterns of the upper extremity involve the wrist. quantity of feathers in the aircraft, which can be The most common wrist injury is a Colles’ fracture difficult to remove. However, he adds, crew as a result of falling onto wrists in extension, and the members should not avoid cutting into clothing fragment is displaced dorsally. A Smith’s fracture is where medically necessary: “Better to expose a reverse Colles’ fracture of the distal radius caused than miss an injury, but be cognizant of the by falling onto flexed wrists, but is less common. results.” Clavicle fractures are also very common as a result of falling backwards with the arm outstretched. While none of these injuries is life-threatening and to adapt. often of minimal concern during the initial treatment Emergency medical services are unique, because this of the multi-system trauma patient, they should be profession usually attracts a certain ‘type’ of person. addressed and splinted in some manner in order to We have all heard the term that we are a bunch of prevent worsening the injury during transport. ‘Type A’ people. This is very true to a degree. Most of us are all pretty assertive, sometimes to a fault. Ground support We all tend to be fairly detail oriented, social and Different ski resorts have varying training or safety not have a whole lot of patience. Understanding standards. Many in the US adhere to the National our likeness throughout all venues of emergency Ski Patrol Standard of Outdoor Emergency Care or services will help promote a team approach from an equivalent. Indeed, many areas require their ski the on-the-hill injury to the back of the helicopter, no patrol to have emergency medical technician basic matter how experienced or inexperienced the ‘team’ training, and some areas are staffed with personnel may be. with paramedic level of care. While the size of the Ski patroller training varies by resort and, most mountain is not a deciding factor regarding the level importantly, it varies by region. For example, there of care that can be provided, the local resources are some ski areas that do not need to worry about are often used to complement on-the-hill care. avalanche mitigation and control, and there are some While most ski areas have either an on-site clinic resorts where one of the primary daily activities is for basic first aid, many resorts are developing avalanche forecast and control work. This variation mountain clinics that can be staffed by advanced is the same for medical backgrounds and training scope providers, nurses, physician assistants, and provided. Many ski resorts throughout the US rely doctors. For the on-the-hill injuries there will always on a volunteer ski patrol component, and many of be a two-stage process to the treatment of every these patrollers have the basic training required to patient: the initial on-the-hill exam and treatment, rapidly assess, identify, and treat many life-threatening Tenarus International Travel Insurance Journal FEATURE 31

ITIJ spoke to Dr Tim Hammond, chief medical officer for emergency medical assistance and claims management company CEGA Group Services, about the best way to treat injured snow sports enthusiasts. Here’s what he had to say

"The repatriation of an injured skier or snowboarder will often be the most cost effective solution for an underwriter, and can also be the best solution for the patient, since it offers them continuity of care from initial surgery to rehabilitation, in their home country. If it is safe to do so, an individual with minor injuries should be brought home for treatment once a thorough assessment of their condition has been made and they have been stabilised. A good assistance company will then ensure that they have all the necessary support on their journey home to make them comfortable. They will find out, for instance, if the patient can sit with their feet on the floor for take-off and landing, if they need leg elevation during the flight or if they can manage their own luggage. The patient may need extra leg room to accommodate an injured knee, an extra seat to give them space around an injury or, if they can't sit comfortably, a stretcher. If they do need a stretcher, it can sometimes be quicker and more cost effective to bring them home in an air ambulance rather than wait for a commercial flight. If an individual has suffered major trauma and is not in a fit state to travel, we would agree to surgery overseas, repatriating only when the patient is stable. Our message to winter sports enthusiasts is to make sure that they always have travel insurance, even if they are travelling to a country where they are covered by EHIC. EHIC won’t cover the cost of repatriation, or treatment in a private hospital – where a pisteur is most likely to take them if they are injured on the Dirk Terpstra slopes. Nor will it cover the cost of transport from the mountainside (often by helicopter), emergencies. Unfortunately, their exposure to or damage to equipment. Policyholders should critical patients with life threatening emergencies also contact their insurance company as soon is sometimes very low in frequency, so excellent as possible after they have suffered an injury, so training programmes are a must. These patrollers that the extent of their cover can be explained. are sometimes complemented in their treatment Their insurance policy will not cover them for by either paid resort employee patrollers or local unnecessary treatment overseas." emergency medical providers. For a ski patroller, assessing and identifying hazards, marking them appropriately, and educating the skiing and snowboarding public is an ongoing job function. For us as air-medical providers we need to understand that often the injuries happen in difficult to access locations, on terrain that is sometimes unstable, icy, or hazardous to access. It will sometimes cause more harm to expose a critical patient or provide all the ‘textbook’ treatments. Patient packaging may sometimes be done in very creative and innovative ways. Training with your local ski patrol or mountain rescue group will improve interactions and ultimately improve patient care. n

Brett Henyon has been involved in emergency services for 22 years. He is a member of the US National Ski Patrol, a certified level patroller (NSP #723) and has been patrolling at Wintergreen Ski Resort for the last 13 years. He is a former flight paramedic and base manager for PHI-Air Medical and also flew for The University of Virginia Pegasus Flight Program; combined he has 11 years of air- medical experience.

www.itij.co.uk 32 ASSISTANCE&HEALTHCAREWORLDMARKETS

An oasis in the desert

Carved out of the Arabian Desert, Dubai has The second largest of seven emirates formed in 1971, Arabia. The discovery of oil in the UAE has been and there was not a single public hospital. become a mecca of bustling commercialism. as part of the United Arab Emirates (UAE), Dubai behind its transformation to a modern state with The UAE’s newly found riches have attracted Forty years ago, it was a small trading and fishing lies in the eastern Arabian Peninsula, bordering the high standards of living – according to the World expatriate workers from all over the world. In 2010, community. Today, it is better known for the Gulf of Oman and the Persian Gulf. Like all the Health Organization (WHO), 50 years ago it was an its population is expected to rise to 7.56 million, world’s tallest building, man-made palm tree- emirates, it is sandwiched between Oman and Saudi impoverished collection of small desert principalities from 5.63 million a year earlier, says Dubai’s Health shaped islands, the six-star hotels of Jumeirah beach and unfettered luxury. Tatum Anderson reveals what the emirate offers to the millions of The discovery of oil in the UAE has been behind its transformation expatriate workers and holidaymakers in need of care in the country’s burgeoning healthcare system to a modern state with high standards of living

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 33

The downturn has claimed a few casualties in Dubai’s health sector too. The Mayo clinic, which opened its first clinic outside the US in the boom times of 2005 has closed, albeit temporarily

available in the principal cities of the UAE, says overseen by the UAE’s Ministry of Health. Indeed, the US State Department, but not much outside the DHA is responsible for the governance of all these areas. There are around 26 hospitals and 106 the government hospitals, smaller clinics and 20 primary healthcare centres across the UAE. primary health centres throughout the emirate. The medical care of Dubai nationals, visitors and According to the DHA, there is one health centre resident expatriates is managed by the Dubai Health or clinic for every 30,000 individuals and many Authority (DHA), one of six federated authorities run by an international staff that hails from India

Authority. And of that figure, around 80 per cent Middle East. It sent global markets tumbling at the are expatriates. Half of the population of Dubai is end of 2009 after one of its investment companies, South Asian, although there are many Westerners Dubai World, applied for a six-month extension too – over 120,000 British expats live in the region from creditors. for instance. The population of Dubai has followed a similar Health matters trajectory, increasing by 7.6 per cent from 2009 The downturn has claimed a few casualties in to 2010. Some estimates suggest Dubai swells by Dubai’s health sector too. The Mayo clinic, which more than 10,000 new residents every month. It opened its first clinic outside the US in the boom has mushroomed in recent years by diversifying times of 2005 has closed, albeit temporarily. A few away from a dependence on oil revenues (it has hospital building projects are being delayed too, smaller oil reserves than other emirates) and towards say insiders, but things are picking up. Today, the commercial property and other business interests, standards of healthcare for both western expats and including tourism. Visitors swarm towards its beach tourists rival those found in the developed world. resorts, golf courses and luxury hotels and it can still Private facilities are generally comparable with those charge some of the highest average room rates in of the UK, for instance. In contrast, standards vary the world, despite the global economic downturn. at public facilities and are generally not comparable This is surprising given that Dubai was perhaps to private hospitals. the highest profile casualty of the downturn in the There are plenty of modern basic public facilities www.itij.co.uk 34 FEATURE

and Sudan to the countries of the Middle East. Th e best-known government hospitals include, but are not limited to, Rashid Hospital, Dubai Hospital, Al Wasl Hospital and Hatta Hospital. Al Wasl Hospital is considered the de facto facility for women across the northern Emirates. Rashid Hospital, meanwhile, has 582 beds and every year treats approximately 14,759 inpatients, 138,000 emergency patients and 121,692 outpatients. Peter Hogg of Neuron, a Dubai-based healthcare administration company, says that although standards in public facilities are not comparable to private hospitals, things are getting better. “Improvements have been made and the trauma unit at Rashid Hospital is world-class. Al Wasl is possibly one of the best places to have a baby unless you are concerned about the comfort,” he says, adding, “I believe that they are quite capable of dealing with foreigners.” English is used widely, although speakers of other European languages are few and far between. Many public hospitals are not used to dealing with insurance procedures and international assistance companies, adds Hogg, while some others are not equipped to accept credit cards and work on a cash basis, for instance. “Th ey won’t be good at producing paperwork or getting authorisations,” he warns. Healthcare is free for UAE nationals and funded from the government’s coff ers, despite there being no tax or social security payments.

The private clinics in Dubai are adept at handling claims directly with third party administrators and insurers based in Dubai, and at filling in the forms needed for visitors

You get what you pay for For foreigners either visiting or working in Dubai, only emergency services are free and only then until a patient is stabilised. After that, facilities will expect cash or credit card payment for further treatments, hence why expatriates require some

form of health coverage. Th e penalties low-cost medical treatment at public hospitals and for not being covered are high – for clinics. Public hospitals supply application forms instance, people can be prevented from in Arabic, which can be submitted, along with the leaving the country until they have paid appropriate documents, at a local healthcare centre. for whatever healthcare treatment they Th e card costs around 300 United Arab Emirates have received, and bills can be extremely Dirham (AED) (AED100 = US$27 or 20) and expensive, say experts. must be accompanied by a medical examination that Foreigners without private health costs AED200. insurance coverage are advised by the All workers applying for a work or residency permit DHA to apply for a health card. Valid must undergo medical testing within the fi rst three for one year, the card entitles residents to months of residence, conducted almost universally International Travel Insurance Journal

36 ASSISTANCE&HEALTHCAREWORLDMARKETS

without counselling or consent. Those testing positive for a range of diseases may be deported. A There are plenty of modern basic public facilities available in the US State Department Report on human rights in 2008 reckoned the UAE deported 1,518 non-citizen principal cities of the UAE, says the US State Department, but not residents infected with HIV, hepatitis types B and C, and tuberculosis that year. In August 2010, the much outside these areas rules were relaxed slightly for expats coming to work in the emirate, as the DHA scrapped mandatory testing for hepatitis C, while hepatitis B testing is only applied to a handful of professions. There is no law to compel employers to provide healthcare facilities. However, some provide on-site clinics, facilities at labourers’ accommodation or buy bulk services from private clinics. That said, Dubai has long been considering various plans to introduce a compulsory insurance scheme and what it eventually establishes will be similar to others that have recently been introduced to the Middle East. Saudi Arabia and Abu Dhabi have in recent years begun insurance schemes that compel employers to buy medical insurance for all employees and their families. Both expats and UAE residents, at least those who can afford it, are more likely to use private facilities. The UAE boasts 15 internationally accredited hospitals. The private sector caters to several very different groups of expats, according to Neuron’s Hogg. “The private sector caters for all the different racial and socio-economic groups present in Dubai, from up-market clinics catering to westerners and others [in this income group] to much more basic low-cost providers that cater to labourers.” As a result, prices for care can vary widely. A consultation with a GP will range from US$15 to $140, while an angiogram and angioplasty might cost anything between $10,000 to $20,000. Dubai’s healthcare costs are much cheaper than Western countries, but still around double that of Southeast Asia, according to Alpen Capital, a Dubai-based consultancy firm. A cardiac bypass costs around $130,000 in the US, compared with $44,000 in the UAE. The same surgery costs around $18,500 in Singapore and $11,000 in Thailand. International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 37

population, but it spends a fraction on healthcare for its citizens compared to other countries.

Conclusions So, luxury private facilities aside, Dubai still lacks the expertise and specialist hospitals to deal many health challenges, according to local and international experts. Together with other emirates, it spends approximately AED7.5 billion ($2 billion) every year to send its own citizens abroad to receive treatment that is not available locally. In 2007, Dubai alone sent close to 1,000 patients overseas for medical care at a total cost of over AED176 million ($48 million). The majority of these patients were treated in Germany, the UK, US and India, and most consultations were in the fields of oncology, cardiology, paediatrics and orthopaedics. There is also an acute shortage of human resources and the region relies to a large extent on expatriate staff. Some estimates put the proportion of expat nurses in UAE at a whopping 92 per cent, says Alpen Capital. And with two physicians per 1,000 population, Gulf States rank below the US and Europe, which have 2.6 and 3.2 doctors per 1,000 people respectively. Yet there is a growing need for healthcare facilities as the emirate ages and increasingly suffers from diseases of affluence (the UAE ranks second highest in the world for diabetes prevalence at 20 per cent and has a significant obesity problem). The health authorities in the UAE predict that demand for hospital beds will increase by 160 per cent by 2025, and of course, it will need a corresponding rise in staff. Health reforms are also afoot in more than one emirate: the DHA is restructuring, for example, and there are many grand hospital-building projects planned across the region Dubai Healthcare City under construction (there are at least three maternity hospitals being built for instance). But how much a proliferation of Choice of facilities by the Dubai-based Varkey Group, Medi-Clinic However, there remain significant gaps in Dubai’s hospital projects across the region will duplicate each The private clinics in Dubai are adept at handling Corporation (South Africa) and GE Healthcare, the healthcare system. The UAE may be the world’s fourth- other and cannibalise the already limited human claims directly with third party administrators and 210-bed City Hospital won JCI accreditation in largest oil producer and the richest state per head of resources should be a point of concern. n insurers based in Dubai, and at filling in the forms June 2010. Its sister hospital is Welcare, which has needed for visitors. However, occasionally, smaller traditionally ranked as one of the best in Dubai. The clinics run by individual doctors are not. “They are City Hospital, says Hogg, is now overtaking Welcare not so happy dealing directly with insurers, but even in reputation, and the quality bar is much higher so they are well able to complete the forms needed here too. According to experts, higher qualifications to get the claim reimbursed back home,” says are required for doctors practising within DHCC Neuron’s Hogg. than those outside. City, like most other private There is a good range of high-quality facilities facilities, operates 24-hour services and is equipped available for expats or to handle most tourists who need hospital emergencies. treatment. The American That said, in the Hospital Dubai has been event of a major widely recommended. A accident patients 143-bed, acute care, general are automatically medical/surgical hospital, All workers applying taken to the it trades on the fact that it public Rashid can provide an American for a work or residence Hospital, which standard of healthcare and is considered was the first in the Middle permit must undergo better equipped East to be accredited by for major the Joint Commission medical testing within traumas. In this International (JCI) case patients are accreditation scheme. It has the first three months normally collected a 10-bed intensive care unit; by government a 10-bed cardiac intensive of residence, conducted ambulance. care unit, emergency However, those services and a 13-bed who choose to paediatric suite, among a almost universally without go to a private host of other services. hospital instead In addition to facilities counselling or consent must pay a charge such as the American for the ambulance Hospital Dubai, Dubai on the spot. Costs Healthcare City (DHCC) for international is an entire area dedicated repatriation vary to international healthcare considerably, with and home to two hospitals, around 90 medical a flight to the UK costing anything from around facilities and 1,700 healthcare professionals. Many $30,000 to $70,000 depending on the company major national and international brands operate used. Hogg of Neuron says local air ambulance here, including Moorefield’s Eye Hospital and companies as such don’t exist, but some of the Harvard Medical School. University Hospital, nearby executive carriers will convert their planes to the first in Dubai, is also under construction in carry people regionally. “This is not a well-developed the city. And City Hospital is one of the most area, but equally there doesn’t seem to be too much highly recommended hospitals in DHCC. Owned demand,” he adds. www.itij.co.uk 38 PROFILE A good sport

ITIJ recently spoke to Mark Lee, partner and head of the travel law team at Penningtons Solicitors LLP in the UK, to find out his opinion on some pertinent legal matters and to learn more about his passion for sport and travel

Where were you born, where were you Can legal expenses insurers oblige What is the most interesting educated, and where do you live now? a policyholder to use their panel case you have worked on I was born in Sussex in the UK and brought up on solicitors? recently, or that which you the coast close to Chichester. I went to a local school The ECJ’s decision in the case of Eschig has count as your most successful until I was 13 and then attended Canford School certainly muddied the waters regarding the case? in Dorset. After studying at university in Bristol, I right of a policyholder to choose his own Since joining Penningtons, I have moved to London where I lived in Balham for six solicitor. Before Eschig, UK Legal Expenses been handling a case involving a years. My wife and I left London and moved to Insurers (LEIs) routinely insisted on their own little girl who fell into a coma after Haslemere in Surrey in 2009, a few months after I panel solicitors up to the issuing of proceedings, nearly drowning in an apartment joined Penningtons. relying upon the Insurance Companies (legal swimming pool in Spain. She expenses insurance) Regulations 1990. This was permanently disabled as a What attracted you to the law profession, approach was also formally approved by the consequence of the incident, but and in particular to travel law? Financial Services Ombudsman. However, was unfortunately unable to pursue Having studied a Law and French and Spanish in Eschig, a group action claim, the ECJ a claim against a tour operator in degree, I wanted to continue using my languages and disagreed: It held that European law guarantees the UK since their holiday did not I also enjoyed the cut and thrust of litigation during a policyholder the right to choose his own constitute a package. Liability was my university studies and whilst doing my training solicitor from the moment he has a right to disputed and we were, therefore, contract. Travel law allowed me to mix the two and claim legal expenses cover from his insurer. forced to initiate court proceedings also to deal with people, so it was an easy choice against numerous Defendants for me. in Spain, to include the lifeguard company, various communities What trends has your department of owners and their insurers. I witnessed recently? accompanied the girl’s family at the The main change in the last couple of years has trial in Spain last year and the Judge been the higher volume of claims emanating We have also noticed found in her favour, which means from countries outside the eurozone, such as her family can now afford for her to Turkey, Egypt and Bulgaria. This is primarily more compensation be given the care she needs in the because fewer British tourists are travelling to future. European destinations, as currency changes mean European holidays are comparatively much claims against credit If you could be in any other more expensive. We have also noticed more profession, what would it be? compensation claims against credit card suppliers card suppliers for I always wanted to be a vet when for accidents that occur during a component I was younger and that is still a of the holiday paid for by the credit card – for accidents that occur profession that appeals to me. example, on an excursion – than in previous years. I also think travel insurers are now How do you spend your free generally more aware of their right of subrogation during a component time/do you have any hobbies? as regards possible recoveries. Margins are I am a keen sportsman and enjoy tight for travel insurers and they are, therefore, of the holiday paid playing for the Penningtons five-a- naturally anxious to reduce leakage as much as side football team and the cricket possible. team in the summer. The South for by the credit card Downs and Surrey hills are also Have you been involved in any cases both great areas for cycling/running regarding a contractual dispute between – for example, on an (assuming you like hills!) so I try to a travel insurer and a policyholder? get out and about whenever I can at Insurers ask us to help defend proceedings issued excursion weekends. by disgruntled policyholders for alleged breaches of the travel insurance contract. Typically, these What’s your favourite holiday actions relate to declined claims for lost baggage destination so far, and where or medical expenses. We try to give sound would you like to go next? commercial advice to the insurer since legal costs That’s a tough one as I have will usually be irrecoverable if the amount in dispute This legal right was not just limited to cases been lucky enough to visit some is less than £5,000. where proceedings had already commenced, fascinating places. I guess my trip to but, instead, exists from the outset of the claim Rwanda and Uganda would have How has the Rome II Regulation worked in – that is, at the initial enquiry stage. Despite to come out top, with Argentina practice? mixed messages from the FSA, the latest letter and Chile a close second. I would Following Rome II, it is now generally accepted that to LEIs from Ken Hogg, the Financial Services love to return to South America, the law applicable to the quantification of damages Authority’s (FSA) insurance director, reiterates probably Brazil, so I am already in for accidents in Europe is the law where the the broad principle that the freedom to choose negotiations with my wife for a trip accident occurs, even if the compensation claim is a lawyer under Article 4 of the Directive is to the World Cup in 2014. subsequently pursued in the UK. However, there still guaranteed, but restricted to recourse to a remain some areas of potential dispute. For example, lawyer in ‘any enquiry or proceedings’ and If you were having a dream a Judge may still apply English law if it is ‘clearly only triggered once efforts to settle the claim dinner party, who would be more closely connected to the issues than that of by negotiation have failed. To my mind, the there and what would you eat? the place where the injury occurred’, although the LEIs can therefore still insist on their preferred I imagine an evening with Marilyn circumstances must be truly exceptional. There is solicitors, at least up until the point when the Monroe, Mohammed Ali, Mick also still significant disagreement regarding the actual parties are in contemplation of proceedings. Jagger and Stephen Fry would be date of application of Rome II, and the European Others disagree, not least the Association of one to remember. I love Spanish Court of Justice (ECJ) has now been asked to Personal Injury Lawyers, so these arguments food so would go for a mixed paella determine this issue. will rumble on for a while yet. or a delicious selection of tapas.

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

AMREF Flying Doctor Service ) Medical Wings Dr Bettina Vadera – Medical Director Dr Sommart Somsiri – Medical Director 222 Room 3259, Donmuang Int Airport Moo 10, Viphavadee-Rangsit Rd, Sikan, Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA Don Muang, Bangkok 10210, THAILAND tel: +254 20 6000 090 email: [email protected] tel: +662 247 3392 email: [email protected] (AFRICA) fax: +254 20 344 170 website: www.amref.org fax: +662 535 4355 website: www.medicalwings.com

Netcare 911 International South Pacific Air Ambulance AUSTRALASIA

Jacques Pienaar – Fixed Wing Operations Manager ( Scotty Watson – Managing Director AIR AMBULANCE AIR AMBULANCE Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA NEW ZEALAND AUSTRALIA SINGAPORE

tel: +27 10 209 8392 email: [email protected] tel: +64 9256 9000 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +64 9256 9111 website: www.spaa.co.nz

West African Rescue Association ADAC-Ambulance Service Florian Zagel – Managing Director Robert Glueck – Marketing & Sales Director Klotey Cresent 6, North Labone, Accra, GHANA Am Westpark 8, 81373 Munich, GERMANY

24hr tel: +233 243 666 111 email: [email protected] (EUROPE) tel: +49 89 76 76 52 85 email: [email protected] tel: +233 302 781 258 website: www.westafrican-rescue.com 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance ) AeroMed Asia Inc. Air Medical Ltd Cindy Wong / Lorraine Paul – International Account Management Glenn Salt – Flight Operations Manager SINGAPORE BANGKOK THAILAND Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK

tel: +603 7965 3883 email: [email protected] tel: +44 1865 842 887 email: [email protected] fax: +603 7629 8810 website: www.aeromed-asia.com tel: +44 1865 370 642 website: www.airmed.co.uk AUSTRALASIA ( AirMed International LLC Augsburg Air Ambulance Jeffrey T Tolbert – President Roland Schoberth – Director Airport World Trade Center, 1 Sky Plaza Road, Roseggerstr 17, D-86368, Gersthofen, GERMANY Hong Kong International Airport, HONG KONG tel: +852 3756 3680 email: [email protected] tel: +49 821 299 1020 email: [email protected] fax: +852 3756 3681 website: www.airmedasia.com tel: +49 821 299 2030 website: www.ambulanzflugdienst.de

CareFlight Group Capital Air Charter Medical and Tasking Centre Lisa Humphries – Sales Director PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA Exeter International Airport, EX5 2BD, UK

24hr tel: +61 7 5553 5955 email: [email protected] tel: +44 845 055 2828 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +44 1392 350 039 website: www.capitalaircharter.co.uk

CareFlight International European Air Ambulance Paul Smith – National Manager Patrick Schomaker – Director Sales & Marketing Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA 175A, rue de Cessange, L-1321, LUXEMBOURG

tel: (+61) 2 9893 7683 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: +61 2 9689 2744 website: www.careflight.org fax: +49 711 7007 7009 website: www.air-ambulance.com

Flying Doctors Asia FAI – rent-a-jet AG Prithpal Singh – CEO , Director Volker Lemke – Director Sales & Marketing 313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, Flughafenstrasse 100, D-90268 Nuremberg, GERMANY SINGAPORE 24hr tel: +65 9297 7757 email: [email protected] tel: +49 911 36009 31 email: [email protected] fax: +65 6483 5407 website: www.flyingdoctorsasia.com fax: +49 911 36009 59 website: www.rent-a-jet.de

Hope Medflight Asia Pte Ltd German Red Cross Air Ambulance Service Dr Charles Johnson – Medical Director Andreas Speich – Managing Director 2 Loyang Lane 03-01, Singapore 508913, SINGAPORE Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY

24hr tel: +65 6100 1911 email: [email protected] tel: +49 228 2300 23 email: [email protected] fax: +65 6400 5254 website: www.hope-flight.com fax: +49 228 2300 27 website: www.grcairambulance.de

Medic’Air International Greek Flying Doctors Dr Herve Raffin – General Manager Dimitris Kanellis – Manager 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE

tel: +33 141 72 1414 email: [email protected] tel: +30 210 674 0600 email: [email protected] fax: +33 148 57 1010 website: www.medic-air.com fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

CATEGORY KEY CLAIMS MANAGEMENT INSURERS IAS Medical George Ditchburn – Operations Manager AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE 145-157 St John Street, London, EC1V 4PY, UK AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +44 870 042 1465 email: [email protected] INTERIOR SPECIALISTS fax: +44 870 042 1480 website: www.iasmedical.com AIRCRAFT PERFORMANCE CRITICAL CARE SOLUTION PATIENT TRANSPORT MEDICAL SCREENING IFRA ASSISTANCE FUNERAL DIRECTORS RE-INSURANCE COMPANIES Dr Christian Steindl – Director CATASTROPHIC CLAIMS Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS WEB & DESIGN tel: +43 2732 825 610 email: [email protected] COST CONTAINMENT HOSPITALS SERVICES fax: +43 2732 851 01 website: www.ifra.at call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41

) Jet Executive International Charter AirMed International LLC Irena Dimitrijevic – Marketing & Sales Jeffrey T Tolbert – President Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA “Homebase FRA & MUC” tel: +49 211 602 7775 email: [email protected] tel: +1 205 443 4840 email: [email protected] EUROPE

( fax: +49 211 602 77766 website: www.jetexecutive.com fax: +1 205 443 4841 website: www.airmed.com

Mayoral Executive Jet Global Jetcare, Inc. Juan Carlos García Caparrós – Commercial Director Bart Gray – President AIR AMBULANCE AIR AMBULANCE

Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN (NORTH AMERICA) 16479 Runway Drive, Brooksville, FL 34604, USA

tel: +34 952 048 609 email: [email protected] tel: +1 352 799 7771 email: [email protected] fax: +34 924 048 612 website: www.mayoralaviation.com fax: +1 352 799 7776 website: www.globaljetcare.com

Medic’Air International JET ICU Dr Herve Raffin – General Manager Mike Honeycutt – President 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE 2561 Rescue Way, Brooksville, FL 34604, USA

tel: +33 141 72 1414 email: [email protected] tel: +1 352 796 2540 email: [email protected] fax: +33 148 57 1010 website: www.medic-air.com fax: +1 352 796 2549 website: www.jeticu.com

Medilink International Air Ambulance LIFESUPPORT Patient Transport Martin Farrugia – Business Development Manager Graham Williamson – CEO 99 Mill Street, Qormi, QRM 3100, MALTA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +356 2278 5400 email: [email protected] tel: +1 250 947 9641 email: [email protected] fax: +356 2278 5700 website: www.mi-aa.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com

North Flying a/s Skyservice Air Ambulance Jesper Kragelund – Sales Manager David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK H9P 1A2, CANADA tel: +45 9632 2900 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +45 9632 2909 website: www.northflying.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

Redstar Aviation AIMS Mustafa Atac – CEO Bernadette Breton – Managing Director Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA

tel: +90 216 588 0216 email: [email protected] (AFRICA) tel: +00 27 11 783 0135 email: [email protected] fax: +90 216 588 0225 website: www.redstar-aviation.com fax: +00 27 11 783 2950 website: www.aims.org.za

Swiss Air Ambulance / Rega AMREF Flying Doctor Service Peter Meierhans – Director of Sales Dr Bettina Vadera – Medical Director PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +41 333 333 333 email: [email protected] tel: +254 20 6000 090 email: [email protected] fax: +41 44 654 3590 website: www.rega.ch fax: +254 20 344 170 website: www.amref.org ASSISTANCE COMPANIES ASSISTANCE

Tyrol Air Ambulance Interhealth Technologies Jakob Ringler – Managing Director Kevin Thomas – Director - International PO Box 81, A-6026, Innsbruck Airport, AUSTRIA P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: +43 512 224 220 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +43 512 288 888 website: www.taa.at fax: +27 11 622 8264 website: www.interhealth.net

Aero Jet International Medical Services Organisation (MSO) Stuart Hayman – President Vernon Pillay – Operations Director - International Division 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA

tel: +1 954 730 9300 email: [email protected] tel: +27 (0)11 259 5403 24hr email: [email protected] fax: +1 954 485 6564 website: www.aero-jet.com fax: +27 (0)11 259 5001 website: www.mso.co.za

Air Ambulance Network Netcare 911 International Kirk Pacheco – President Louis Mabele – International Assistance Operations Manager (NORTH AMERICA) 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

24hr tel: + 1 727 934 3999 email: [email protected] tel: +27 (0)10 209 8387 24hr email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +27 (0)10 209 8405 website: www.netcare911.co.za

Air Ambulance Professionals, Inc. West African Rescue Association Brian L. Weisz – President Florian Zagel – Managing Director Ft. Lauderdale Executive Airport, 1535 South Perimeter Rd, Klotey Cresent 6, North Labone, Accra, GHANA Hangar 36B Ft. Lauderdale, Florida 33309, USA tel: +1 954 491 0555 email: [email protected] tel: +233 244 312 496/7 email: [email protected] fax: +1 954 491 6114 website: www.airambulanceprof.com fax: +233 21 781 259 website: www.westafrican-rescue.com

Air Ambulance Specialists To have your company listed in our service directory Tom Cox – Director of Business Development 345 Inverness Drive South, Suite A110, Englewood, Colorado, 80112, USA contact the sales department now: tel: +1 720 875 9182 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +1 720 875 9183 website: www.airaasi.com 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

On Call International ADAC-Ambulance Service Michael J. Kelly – President & CEO Robert Glueck – Marketing & Sales Director One Delaware Drive, Salem, NH 03079, USA Am Westpark 8, 81373 Munich, GERMANY

tel: + 888 289 0567 email: [email protected] tel: +49 89 76 76 52 85 email: [email protected]

fax: +1 603 328 1770 website: www.oncallinternational.com (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance (AMERICAS) SelectCare Worldwide Altas Assistance Magdi Riad – President Arvydas Bebravi˘cius – Managing Director #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA

tel: +1 416 340 7265 email: [email protected] tel: +370 5 264 4020 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +370 5 264 4021 website: www.altas-assistance.lt ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE Asia Assistance Partners AP Companies Siriporn Wongurai – International Operations Director Natalya Butakova – Business Development Manager 184/235 Forum Tower, 36 Flr Ratchadapisek Rd Huaykwang, Bangkok 10320, str. 9, dom 5/7, ul. Nizhnyaya Syromyatnicheskaya, Moscow 105120, RUSSIA THAILAND tel: +662 645 3733-5 email: [email protected] tel: +7 495 989 1120 email: [email protected] fax: +662 645 3732 website: www.aapartners.net fax: +7 495 989 1130 website: www.ap-companies.ru

Assistance Online ARC Europe SA (AUSTRALASIA) Bertrand Guichoux – CEO Hans Biekmann – Network Director Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA Avenue des Olympiades 2, 1140 Brussels, BELGIUM

tel: +86 21 6104 9500 email: [email protected] tel: +32 2 706 6660 email: [email protected] fax: +86 21 6104 9484 website: www.assistanceonline-china.com fax: +32 2 706 6601 website: www.arceurope.com

Customer Care Pty Ltd CNAS Louise Heywood – Business Development & Marketing Manager Carole Luisy – Managing Director Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA 80 rue des alliés, 38100, Grenoble, FRANCE

tel: +612 9202 8222 email: [email protected] tel: +33 438 49 83 49 email: [email protected] fax: +612 9202 8220 website: www.customercare.com.au fax: +33 438 49 83 40 website: www.cnas-assistance.com

To have your company listed in our service directory DRK Assistance Andreas Speich – Managing Director contact the sales department now: Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY [email protected] or telephone: +44 (0)117 922 66 00 tel: +49 211 2711 2020 email: [email protected] fax: +49 211 3018 0527 website: www.drkassistance.com

Dynamiq Global Assistance a.s. Janine Benson – Director of Emergency Assistance Petr Bold – General Manager Level 5/33 York St, Sydney 2000, NSW, AUSTRALIA Dopraváku˚ 749/3,184 00 Prague 8, CZECH REPUBLIC

tel: +61 (0) 2 9978 6600 email: [email protected] tel: +420 266 799 770 email: [email protected] fax: +61 (0) 2 9888 3609 website: www.dynamiq.com.au/assist fax: +420 266 799 797 website: www.1220.cz

First Assistance Global Voyager Assistance - Russia Mary-Jo McDonald – General Manager Costas Danilenko – CEO PO Box 17-310, Greenlane, Auckland, NEW ZEALAND PO Box II, 125124 Moscow, RUSSIA

tel: +64 9 356 1650 email: [email protected] tel: +7 495 775 0999 email: [email protected] fax: +64 9 525 1278 website: www.firstassistance.co.nz fax: +7 495 775 0998 website: www.gvassistance.com

Global Assistance & Healthcare Global Voyager Assistance - Black Sea Mario Babin – Chief Executive Officer Olga Turubarova – General Manager Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, 77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE Jakarta 12560, INDONESIA tel: +62 21 299 78 999 email: [email protected] tel: +38 048 7373 441 email: [email protected] fax: +62 21 299 78 9555/66 website: www.global-assistance.net fax: +38 048 7373 442 website: www.gvassistance.com

South Pacific Air Ambulance Greek Flying Doctors Scotty Watson – Managing Director Dimitris Kanellis – Manager NEW ZEALAND AUSTRALIA SINGAPORE 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE

tel: +64 9256 9000 email: [email protected] tel: +30 210 674 0600 email: [email protected] fax: +64 9256 9111 website: www.spaa.co.nz fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Marm Assistance Jill Atac – CEO AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +90 216 588 0588 email: [email protected] INTERIOR SPECIALISTS fax: +90 216 588 0602 website: www.marmassistance.com AIRCRAFT PERFORMANCE CRITICAL CARE SOLUTION PATIENT TRANSPORT MEDICAL SCREENING med con team GmbH ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE Michael Weinlich – Managing Director CATASTROPHIC CLAIMS Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS WEB & DESIGN tel: +49 7121 433 660 email: [email protected] COST CONTAINMENT HOSPITALS SERVICES fax: +49 7121 433 619 website: www.medconteam.com call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

Save Assistance France Marm Assistance Franck Molinier – Director of Business Development Jill Atac – CEO 19 rue de Provence, 78310 Maurepas, FRANCE Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +33 13062 6752 email: [email protected] tel: +90 216 588 0588 email: [email protected] (EUROPE) (EUROPE) 24 tel: +33 13062 1122 website: www.saveassistance.com fax: +90 216 588 0602 website: www.marmassistance.com

Savitar Medical Claims International Spain Lydia Semchenkova – Business Development Manager Fatima Guillen Grande – Managing Director 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN COST CONTAINMENT tel: +7 495 987 1775 email: [email protected] tel: 00 34 913 016 145 email: [email protected] fax: +7 495 987 1776 website: www.savitar-gr.com fax: 00 34 913 016 160 website: www.mcimanager.com ASSISTANCE COMPANIES ASSISTANCE SOS International Global Excel Management Helle Drager Sandahl – Communications & Marketing Manager Michael Drew – Vice-President Sales 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +45 7010 5055 email: [email protected] tel: +1 866 566 1130 email: [email protected] fax: +45 7010 5056 website: www.sos.eu fax: +1 819 566 8335 website: www.globalexcel.ca

TBS Team 24 d.o.o Global Medical Management Edvard Hojnik – General Manger Raija Itzchaki – COO (NORTH AMERICA) CROATIA, SLOVENIA, SERBIA, MNE, BH, KOS, MAC 1300 Concord Terrace, Suite 300, Sunrise, Florida 33323, USA

tel: +386 2616 5819 email: [email protected] tel: +1 954 370 6404 email: [email protected] fax: +386 2618 5800 website: www. tbs-team24.com fax: +1 954 370 8613 website: www.gmmusa.com

CONNEX Assistance Middle East Lara Helmi – International Network Director Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: +97 14 257 82 84 email: [email protected] fax: +97 14 257 82 85 website: www.connexassistance.com (MID. EAST) (MID.

IES Medical Eitan Kariv – CEO 2 Yagea Kapaim Street, Tel Aviv, ISRAEL

tel: +972 3 639 9990 email: [email protected] fax: +972 3 687 2950 website: www.iesmedical.co.il

Dr Colin Plotkin & Sons Consulting INC. Dr Colin Plotkin – Managing Director 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +1 604 241 9677 email: [email protected] fax: +1 604 241 0733 website: www.plotkinconsulting.com

To have your company listed in our service directory CATASTROPHIC CATASTROPHIC contact the sales department now:

CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00

AIMS Bernadette Breton – Managing Director Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: +00 27 11 783 0135 email: [email protected] (AFRICA) fax: +00 27 11 783 2950 website: www.aims.org.za

Interhealth Technologies Kevin Thomas – Director - International P O Box 3058, Bedfordview 2008, SOUTH AFRICA COST CONTAINMENT tel: +27 11 622 8010 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net

Medical Services Organisation (MSO) Vernon Pillay – Operations Director - International Division PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA

tel: +27 (0)11 259 5403 24hr email: [email protected] fax: +27 (0)11 259 5001 website: www.mso.co.za

ChargeCare International Christiane Burniston – Managing Director Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

(EUROPE) tel: +44 1865 400 007 email: [email protected] fax: +44 845 003 9923 website: www.chargecareinternational.co.uk 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Olympus Managed Healthcare LIFESUPPORT Patient Transport Steven Jacobson – CEO Graham Williamson – CEO 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +1 305 530 8600 email: [email protected] tel: +1 250 947 9641 email: [email protected] fax: +1 305 530 0766 website: www.omhc.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com

OneWorld Assist SPECIALISTS Voyageur Aeromedical Travel Taka Katsube – Director Assistance & Cost Managment Marc Lucas – General Manager

(NORTH AMERICA) 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK COST CONTAINMENT tel: +1 604 303 2113 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

fax: +1 604 276 4593 website: www.oneworldassist.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur24.com

SelectCare Worldwide ADAC Magdi Riad – President Christoph Ullrich – Director of Purchase / International Network #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Am West Park 8, 81373 Munich, GERMANY

tel: +1 416 340 7265 email: [email protected] tel: +49 89 7676 2912 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT Star Healthcare Lufthansa Medical Services Gigi Galen – President Doris Ehring – Manager Sales & Marketing Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, 850 7th Avenue, Suite 803, New York, 10019, USA Frankfurt/Main, GERMANY tel: + 1 212 581 8228 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] fax: + 1 212 581 8272 website: www.starhealthcarenet.com fax: +49 (0)69690-58147 website: www.dlh.de CRITICAL CARE PATIENT PATIENT CARE CRITICAL

UnitedHealth International Albin Repatriation Ltd Philip Brun – Vice President of Sales & Service Emerson De Luca – General Manager 3100 SW 145 Avenue, Miramar, FL 33027, USA 83 Westbourne Grove, Bayswater, London W2 4UL, UK

tel: +1 954 378 0694 email: [email protected] tel: +44 20 7313 6920 email: [email protected] fax: +1 954 378 0771 website: www.uhgi.com fax: +44 20 7313 6999 website: www.albininternational.com

Global Assistance & Healthcare ANUBIS International Repatriation Mario Babin – Chief Executive Officer Fabrice Kana – Development & Quality Manager Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Tour Pleyel, 93200 Paris, Saint Denise, FRANCE Jakarta 12560, INDONESIA

tel: +62 21 299 78 999 email: [email protected] FUNERAL DIRECTORS tel: +33 149 195 960 email: [email protected] fax: +62 21 299 78 9555/66 website: www.global-assistance.net fax: +33 149 471 901 website: www.anubisgroup.org

Global Excel Management Funeral Home AURIGA Ltd. Michael Drew – Vice President of Sales Helen Pradova – Chief of International Department 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC 17548 Deer Isle Circle, Winter Gdn, FL 34787, USA tel: +1 866 566 1130 email: [email protected] tel: +420 724 257 899 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: +420 416 735 800 website: www.funeral-assistance.cz CLAIMS MANAGEMENT

Interhealth Technologies Funeralcare International Kevin Thomas – Director - International Louisa Killen – Repatriation Specialist P O Box 3058, Bedfordview 2008, SOUTH AFRICA Murray House, 50 Whitta Road, Manor Park, London, Essex E12 5DA, UK

tel: +27 11 622 8010 email: [email protected] tel: +44 20 8788 5303 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk

SelectCare Worldwide John Allison Monkhouse Co., Ltd (Thailand) Magdi Riad – President Apple Kaewprasert – General Manager President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Klongtoey, Bangkok, THAILAND tel: +1 416 340 7265 email: [email protected] tel: +66 2382 5345-7 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +66 81 584 5942 website: www.monkhouse.com.au

Star Healthcare Lutece International Gigi Galen – President Zouhaier Hertelli – Repatriation Specialist 850 7th Avenue, Suite 803, New York, 10019, USA 56 rue Olivier de Serres, 75015 Paris, FRANCE

tel: + 1 212 581 8228 email: [email protected] tel: +33 1 56 08 00 23 email: [email protected] fax: + 1 212 581 8272 website: www.starhealthcarenet.com fax: +33 1 56 08 00 43 website: www.pflutece.com

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Mortuary Brussels Airport | Worldwide Funeral Repatriations part of DELA Greta Plas – Repatriations Manager AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE Ringlaan 49, 1930 Zaventem, BELGIUM AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +32 2 720 80 00 email: [email protected] INTERIOR SPECIALISTS fax: +32 2 720 88 22 website: www.repatriations.com AIRCRAFT PERFORMANCE CRITICAL CARE SOLUTION PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE To have your company listed in our service directory COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS contact the sales department now: SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS WEB & DESIGN [email protected] or telephone: +44 (0)117 922 66 00 COST CONTAINMENT HOSPITALS SERVICES call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

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

tel: +44 20 8684 2324 email: [email protected] tel: +30 210 674 0600 email: [email protected]

fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk (EUROPE) fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

Servilusa Redstar Aviation Vanda Castro – Manager International Department Mustafa Atac – CEO Agencias Funerarias SA, International Dept. Rua do Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL

FUNERAL DIRECTORS tel: +35 121 470 6300 email: [email protected] tel: +90 216 588 0216 email: [email protected] fax: +35 121 470 6499 website: www.servilusa.pt fax: +90 216 588 0225 website: www.redstar-aviation.com

BUPA Cromwell Hospital Voyageur Aeromedical Travel Shams Maladwala – Commercial Director Marc Lucas – General Manager Cromwell Road, London SW5 0TU, UK Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: +20 7460 2000 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

(EUROPE) fax: +20 7835 2444 website: www.cromwellhospital.com fax: +44 (0)117 925 5940 website: www.voyageur24.com HOSPITALS HOSPITALS Baptist Health Int. Center of Miami Air Ambulance Network Yohandra Fuentes – Finance Manager Kirk Pacheco – President

8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA AIRLINES COMMERCIAL ON ESCORT MEDICAL 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA

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

(AMERICA) fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: + 1 727 937 0276 website: www.airambulancenetwork.com (N AMERICA) Integrated Healthcare Services To have your company listed in our service directory Brenda Escobar - International Program Coordinator 450 E. Las Olas Blvd., Ft. Lauderdale, FL 33301, USA contact the sales department now: tel: + 1 305 222 6750 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 tel: + 1 305 222 6751 website: www.hcaeastflorida.com

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 (AUSTRALASIA)

Sue Robshaw – Co-ordinator AGENTS TRAVEL Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, contact the sales department now: AUSTRALIA 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

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

每递安国际 Medic’Air International CATEGORY KEY CLAIMS MANAGEMENT INSURERS Dr Huaqun Gao – Medical Director MEDICAL ESCORT ON MEDICAL ESCORT ON COMMERCIAL AIRLINES COMMERCIAL ON ESCORT MEDICAL 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA AIR AMBULANCE CLAIMS SUBROGATION COMMERCIAL AIRLINE tel: +86 2163 558289 email: [email protected] AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER fax: +86 2163 558285 website: www.medic-air.com INTERIOR SPECIALISTS AIRCRAFT PERFORMANCE CRITICAL CARE MEDICAL SCREENING AMREF Flying Doctor Service SOLUTION PATIENT TRANSPORT ASSISTANCE Dr Bettina Vadera – Medical Director COMPANIES FUNERAL DIRECTORS RE-INSURANCE Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS (AFRICA) tel: +254 20 6000 090 email: [email protected] WEB & DESIGN fax: +254 20 344 170 website: www.amref.org COST CONTAINMENT HOSPITALS SERVICES 46 REGULARS GRAPEVINE • GRA PEVINE VINE G RAPEVINE GRAP EVINE VINE •• GRAPEVINE • GRAPEVINE • GRAPEVINE •GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE VINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • VINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • VINE •• GRAPEVINE • •GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE• Letter to Grapevine the Editor Braving the cold Alcohol Never a week goes by that I, as the international medical co-ordinator in a hospital in Thailand, am Four British tourists were arrested in Latvia anchor not exasperated by the foreign tourists who came recently after being found naked astride a life- here with no travel insurance to cover the medical size wooden horse in temperatures of around mistake catastrophes that occur during their vacations. In -15ºC. Police in Riga, Latvia’s capital, said the writing this letter to ITIJ, I realise that I am preach- four men were posing for pictures at the time of A drunken American cruise ing to the choir, but I am frustrated that my efforts their arrest, and were clearly inebriated – there passenger was arrested recently to have the mainstream media publish my concerns are not many people who would feel the need after dropping the anchor on a have met with so little interest. to strip naked in those sorts of temperatures moving liner. Rick Ehlert reportedly When I was planning my trip to Istanbul for the unless under the influence of something, that’s managed to enter a restricted area, International Travel Insurance Conference, I asked, as I usually do, the travel desk at the hospital to for sure! Footage of the drunkards on the horse put on work gloves and release purchase travel insurance for me. Sitting on the has reached YouTube and marked up over the anchor of the MS Ryndam, a plane with hours to burn it is interesting what you 60,000 hits. Holland America ship, in the middle will read and this time I read my policy. The shop- The tourists were taken to a nearby police of the Gulf of Mexico. Just in case ping list of events that will merit a claim are full station to put their trousers back on, whereupon that wasn’t enough to get him into of relative trivialities, lost suitcases, missed flights they were charged with petty hooliganism and trouble, for good measure he then etc. The most important eventuality for which as- handed fines of around £90 each. threw a lifebuoy overboard as the sistance may be needed was listed dead last on the The incident is not the first to be associated with ship made its way towards Tampa, list – evacuation insurance, and on my relatively the wooden horse, as in the past Riga has had Florida. Ehlert was taken into inexpensive policy, it was well covered. General medical coverage for any care needed dur- problems controlling rowdy tourists who feel custody and charged with attempting ing a trip is obviously essential, but there is a trap the need to urinate on the monument, leading to damage a vessel and endangering here. A traveller will call their agent or the com- to public pressure for a heightened police a ship’s safe navigation. If found pany and ask whether medical expenses incurred presence in the area. guilty, he could have to pay a fine while out of the country are covered. When they get a positive reply, they take a deep sigh of relief and decide that travel insurance is not needed. The trap is, of course, that the hospital and physicians Sir Richard … or fees may be covered, but medical transportation back home is not. is it Lady? In Southeast Asia, travellers are understandably concerned about the risk of contracting malaria and Sir Richard Branson is to dress as an air dengue from the pesky little mosquitoes, but they stewardess and serve drinks onboard an Air Asia are worrying about the wrong buzzing little pests – X flight after losing a bet with the boss of the it’s the motorbikes that they should fear. For every low-cost airline. He will be expected to wear malaria patient that we admit, we admit another fifty heels, make-up and a red dress, and will be foreigners who have dismounted from their bikes asked to perform lavatory-cleaning duties. in surprisingly inelegant ways. Those who were not The chairman of Virgin Group is expected to wearing helmets tend to go to Neuro ICU and the work a shift onboard one of Air Asia X’s flights more cautious helmet-wearers to Orthopedics. When they are recovering we start to plan to repatri- between London Stansted and Kuala Lumpur on ate them and then reality really hits. I don’t have to 21 February, according to reports in the media. tell ITIJ readers what may be needed and the fact The move is not a new lifestyle choice for the that they do not have the funding to pay for it. millionaire, though – it has come about because Older visitors have medical or surgical condi- Sir Richard placed a wager with Air Asia X chief tions needing hospital care and again may need executive Tony Fernandes on whose Formula assistance to return home and have no insurance One car racing team would finish higher in this to cover the evacuation. In the last week I have year’s constructors’ championship. had a stroke patient and a patient with a recurrent of around $250,000 and face imprisonment While neither Virgin Racing nor Mr Fernandes’s pneumothorax who needed at the very least busi- ness class accommodation and medical escorts. for up to 20 years. The Federal Bureau of Lotus F1 team scored a single point throughout They had coverage for their medical care but had Mexicana Investigation has weighed into the matter, saying the Formula One 2010 season, Mr Fernandes no coverage for these services. that releasing the anchor could have punctured won the bet by virtue of better finishing I find that patients from countries where there is a stewardesses turn the 719-ft ship and caused it to either sink or be positions. The two bosses agreed the loser national health scheme that covers most medical severely flooded. Fortunately for the rest of the would perform flight attendant duties onboard eventualities are the most likely to travel without entrepreneurs passengers, the ship was not damaged by the one of the other’s aircraft. insurance, with British, Canadians and Australians actions of the drunken passenger. Seats onboard the flight are likely to be being prominent in this group. Female flight attendants from ailing Mexican auctioned, with the proceeds going to a charity Another group that may have a need for this cover- airline Mexicana have come up with a novel of Sir Richard’s choice. age are the expats, particularly the short-stay expats, who may wish in the event of serious medical way in which to bolster their earnings – problems to be taken to their home country and find launching a racy aviation calendar. The 2011 that the insurance provided by their employer does calendar features 10 airline stewardesses in not include this feature. bikinis and sunglasses draped over various I have written an article including some typical different aircraft parts, and is already so cases and have submitted it to the travel sections of popular that the first print run sold out even British and Canadian newspapers and magazines but before it had officially been launched! The have never had it published. In fact, rarely is it even airline they work for has reported debts of acknowledged that I have submitted the article. around £500 million and filed for bankruptcy I read recently that Cuba will not admit travellers who do not have travel insurance. This is to ensure in August 2010, suspending operations soon that hospital care is paid for; an understandable afterwards. policy. Organiser of the calendar Coral Perez told I am not sure what the answer is, but in someway reporters: “It occurred to me because we the travelling public must be made more aware of all needed money, and I thought that with the need for medical evacuation insurance coverage. so many pretty girls there were bound to be some who’d be interested.” The From, stewardesses each paid some money out of Dr Michael Moreton M.B. Ch.B.(UK) FRCS (Canada) their own pockets towards the production International Medical Coordinator costs of the calendar. Bangkok Hospital Thailand GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPE- International Travel Insurance Journal ONTHEMOVE 47

Lloyd’s names Aon moves CL launches claims Foley appointed at

Chaplin Vincent West has joined Aon Risk Solutions, fraud unit the Pru the global risk management business of Aon Lloyd’s of London has appointed claims boss Kent Corporation, to head the global risk consulting team Cunningham Lindsey (CL) has become the UK’s first Prudential plc has announced the appointment of Chaplin as the new head of its Singapore-based Asia in the UK and build upon the success of its business loss adjuster to set up a dedicated unit to tackle the John Foley as group chief risk officer and an executive Pacific operations. Chaplin began the role at the continuity practice. With over 20 years’ experience increase in liability fraud. The most recent figures director on the Board of the company. Previously, beginning of January, replacing Keith Stern, who took in business continuity and risk management, West from the Association of British Insurers reveal that Foley was chief executive of Prudential Capital and up the role of regional manager for the UK and Ireland. will be consolidating and enhancing the intellectual detected liability fraud grew from £194 million in group treasurer, but in his new role he has taken Previously, Chaplin was head of claims for Lloyd’s; a capital and business continuity tools that already exist 2008 to £223 million in 2009. over from Thibaut Le Maire, who left to join HSBC. position that has now been given to chairman of the within the team. Dr Grant Foster, head of enterprise The unit is led by Neil Hanson, who joined Prudential says that the decision to make the position market’s claims service review board David Lang. risk management at Aon, said: “With Vincent joining Cunningham of group chief risk officer a Board role underlines the Jose Riberio, Lloyd’s director of international the team, Aon is now more than ever in a leading Lindsey from importance of risk management for the company. markets, said of the appointment: “I am delighted to position to help businesses cope with such events. I Plexus Law Foley originally joined Prudential in 2000 as deputy welcome Kent to the team. His skills and industry look forward to working closely with him to ensure and brings group treasurer before being appointed managing experience will be an asset to our operations in we remain at the forefront of thinking when it comes with him director of Prudential Capital in 2001. Asia and key to our aspirations to build on Lloyd’s to business continuity and delivering excellence to more than Harvey McGrath, chairman of Prudential, commented presence in this important market.” Chaplin added: our clients.” 18 years on the appointment: “I am delighted to welcome “I am pleased to be given this exciting opportunity Elsewhere, Andrew King has joined Aon’s Claims of industry John to the Board in this role. I am confident that and very much look forward to working with the Consulting practice in the UK to contribute to the experience. his contribution will be significant given his many market to further develop the Lloyd’s platform and development of services across Europe, the Middle He will draw years of experience as a market practitioner and as a extend our footprint in the region.” East and Africa. Joining Aon from Marsh, King on the firm’s manager of risk.” Group chief executive Tidjane Thiam Commenting on the appointment of David Lang, will be working across all industries and focusing existing tools added: “It is a particular pleasure to announce the Lloyd’s director of performance management Tom on claims preparation and management, along and resources appointment of John Foley … [who] has been with Bolt said: “It gives me great pleasure to welcome with business interruption insurance reviews and ­­– with Prudential for more than 10 years and has held senior David to the team. I am sure that he will continue to forensic accountancy. King said of his appointment: almost 40 leadership roles throughout that period.” build on the superb work that has been carried out by “Companies making major claims face the challenge investigators Cath Williams Foley said he was very pleased to take up the role of Kent Chaplin, the market and his team in developing of securing full and fair indemnification at a time when and analysts, group chief risk officer, adding: “I believe Prudential and steering Lloyd’s claims strategy to date.” insurers are looking hard at all components of the cost a nationwide team of field investigators, surveillance is emerging from the global financial crisis as one of of loss. Expert, professional consulting services are operations and intelligence software ­­­­– to help tackle the winners and I am delighted to be appointed at the key to ensuring an insurance policy responds as organised liability fraud. an exciting time in the group’s development. As a intended [and] our team will take a multi-disciplinary Cath Williams, complex technical services director business, we are well positioned to manage the risks AXA chooses Gulf approach to the complex issues involved.” at Cunningham Lindsey, has overseen the set-up of and meet the challenges of an uncertain environment.” the unit. She explained: “Since it was set up four and CEO a half years ago, our Complex Technical Services Unit has made significant savings for our clients, AXA has appointed Jérôme Droesch as chief Aviva chooses Hall identifying £23 million of fraudulent activity in 2009 executive officer (CEO) for the Gulf region. alone. The Liability Claims Fraud Unit is an extension Previously regional CEO for the Southwest region of Aviva has announced the appointment of David Hall of this successful model.” She added: “We detected AXA France, Droesch replaces Jean-Louis Laurent as managing director of corporate risks and speciality this growth in liability fraud some time ago, and we Josi, who has been appointed CEO of AXA Japan. lines in its UK general insurance business. Hall joins have worked with our liability teams to address this Droesch will report to Jean-Laurent Granier, CEO Aviva from Zurich, where he was chief executive threat by building on specialist expertise to establish of the Mediterranean and Latin America region, and officer of its global corporate UK business. In his a dedicated unit to tackle liability fraud, from the will be in charge of the insurance activities of AXA new role at Aviva, he will be responsible for building opportunistic to the very organised. In setting up in Saudi Arabia, the United Arab Emirates, Bahrain, a market leading corporate risks and speciality lines a liability claims fraud unit, we are improving our Qatar and Oman. business and will be part of screening and investigation techniques, and we hope “Under the leadership of Aviva’s UK general insurance to increase the profile of fraud in the liability sector.” Jean-Louis, AXA has become executive team, reporting to Harvey McGrath the first international non-life UK general insurance chief insurer in the Gulf region, executive David McMillan, who one of the more attractive said of the appointment: “We growing markets in the world. are delighted to have someone RBSI appoints head of travel I am convinced that his great of David’s calibre join Aviva, knowledge of the insurance which underlines our ambition RBS Insurance (RBSI) has announced the appointment RBSI. The company said that the appointment was business lines and his people and commitment to grow our of Tom Bishop as head of travel insurance, which is a an important step forward in the plan to grow both and managerial qualities will corporate risks and specialist new role for the company – previously the roles of own brands and the partnerships business, with RBSI serve Jérôme to pursue and lines business. David has a great head of pet insurance and head of travel insurance currently the second-largest insurer in the UK’s travel strengthen the dynamic growth reputation in this market, with were combined. Bishop brings with him extensive market. Alastair Grier, commercial director of RBSI’s in this region with the support a proven track record based experience in the industry, having worked in the past growth portfolio, said: “This senior appointment of AXA Gulf’s teams,” said on more than 20 years in the for Europ Assistance, Travelex and later as operations illustrates our ambition to deliver sustained growth Granier. David McMillan business.” manager in the travel and medical assistance unit of from this business area.”

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