The International Health Insurance Dilemma

Going to China is a very exciting venture and 9/10 of the planning is pure pleasure. Should we go to Tibet or Shanghai during our holidays? How do I figure out the bus route map? How do I pronounce Carrefour? (a French grocery store with a presence in Dalian). The remaining 1/10 consists of what-if scenarios - what happens when I break my leg in Dalian? Do I want Chinese doctors working on me? Will they be able to speak English? Who is going to pay for it? What if I have an accident in the countryside far from any decent hospital? Yes, if you're going overseas it is important buy good international health insurance - if you can find some that won't break the bank.

During my investigation of overseas medical, I've found that the international medical plans that are available fall into 3 general categories.

1) Short term travel insurance that includes medical coverage
2) Full international medical with overseas (non-US/Canada) coverage only
3) Full international medical including US/Canada

You typically can't get 1) if you're going an extended trip (greater than 6 months). The payouts as well are limited (max of $1,000,000 medical on the most generous plans with $50,000-100,000 being more typical). These plans seem to be more geared towards short-term travellers who have full health coverage in their home country and want a little extra comfort that they are covered. For example, a US health plan is not going to pay for emergency medical evacuation from China to the US for critical surgery. Travel insurance will cover this however, typically up to $100,000. The plan premium in this category ranges of course but tends to be $300-800 for a year. Nonethless 1) is not for us given the year-long nature of our trip.

For 2), you can get some pretty good coverage and the companies claim they have put together an international provider network to find doctors that speak English and meet certain minimum criteria. The best example of this plan is the Global Citizen EXP plan offered by HTH Worldwide. This plan is underwritten by Unicare, which seems to be the only US based insurance company that offers these types of plans. Aetna has their Global Benefits plan but they only offer it as a group rates to corporations. All the other companies out there appear to be offshore. The biggest one seems to be Multi-National Underwriters. Their plans don't seem too bad and the premiums are actually reasonable (around $1800 for my wife and I with a $2500 deductible). The problem is that they aren't regulated by any US body. So while their underwriter, Lloyd's is a reputable global insurance market, it makes me a little too nervous to get a MNUI plan given I can't even sue (they are an insurance broker, not provider in the US so they can't be sued). Of course the issue with 2) is that it's only overseas. So all the treatment would have to be in China. This makes the plan significantly cheaper but I am not getting the warmest of fuzzies from being stuck in a Chinese hospital and unable to go home because I have no insurance there.

So we fit into category 3). We need a plan that covers us in the US and abroad. Unfortunately, the Global Citizen plan which has the best looking cover from HTH Worldwide/Unicare is prohibitively expensive. For $3500, my wife and I can get 12 months of coverage with a $2500 deductible overseas and a $5000 deductible back home. We may have to bite the bullet but that's a lot of dough. Fortunately our school will provide up to 10,000 RMB in medical assistance while in China. That's not going to pay for chemo, but it should be sufficient for bumps and bruises.

Summary of companies providing various forms of international coverage:
HTH Worldwide / UniCare
Specialty Risk International
Multinational Underwriters / Lloyd's
International Medical Group / Sirius
TravelGuard International / AIG