Cross-Border PMI for Expats 2026
As an FCA-authorised broker that has arranged over 900,000 policies, WeCovr specialises in helping UK citizens find the right private medical insurance. This guide explores the crucial world of cross-border health cover for expats, ensuring you have peace of mind wherever your work or life takes you.
Serving globally mobile workers
The world of work has transformed. Today, more British professionals than ever are embracing opportunities abroad, becoming part of a dynamic, globally mobile workforce. Whether you're a freelance consultant on a six-month project in Singapore, a tech professional relocating to California, or a family moving to Spain for a better quality of life, one question remains paramount: how do you protect your health?
Standard UK Private Medical Insurance (PMI) is designed for residents of the United Kingdom. It provides fast access to private healthcare within the UK, helping you bypass NHS waiting lists for acute conditions. However, once you move abroad, even for a temporary period, your domestic policy is unlikely to provide the comprehensive cover you need.
This is where Cross-Border Private Medical Insurance, often called International Private Medical Insurance (IPMI), becomes not just a benefit, but a necessity. It’s a specialised form of health cover designed specifically for the needs of expatriates, providing a seamless healthcare safety net across different countries and healthcare systems. In 2026, as global mobility continues to rise, understanding these policies is more critical than ever.
What is Cross-Border PMI and Why is it Essential for Expats?
It's easy to get confused by the different types of insurance available. Let's break down exactly what cross-border PMI is and how it differs from other familiar products like travel insurance.
Cross-Border PMI (or IPMI) is a comprehensive annual health insurance policy designed for individuals and families living and working outside their home country for an extended period (typically more than six months).
Its purpose is to provide cover for medical treatment in your new country of residence and often in other countries too, depending on your chosen area of cover. Think of it as your primary health insurance while you are an expat.
Cross-Border PMI vs. Travel Insurance vs. UK PMI
Understanding the differences is key to making the right choice. Using the wrong type of cover can leave you dangerously exposed to huge medical bills.
| Feature | Cross-Border PMI | Travel Insurance | Standard UK PMI |
|---|---|---|---|
| Primary Purpose | Long-term comprehensive healthcare for expats living abroad. | Short-term emergency medical cover for holidaymakers and business travellers. | Access to private healthcare for acute conditions within the UK. |
| Duration | Annually renewable policies, designed for long-term residence. | Per-trip or annual multi-trip policies, typically for trips up to 90 days. | Annually renewable, designed for UK residents. |
| Scope of Cover | In-patient, out-patient, wellness, dental, maternity, mental health. | Primarily emergency treatment, medical evacuation, trip cancellation, lost luggage. | Primarily in-patient and day-patient treatment for acute conditions in the UK. |
| Routine Care | Often covers routine check-ups, GP visits, and preventative care. | Does not cover routine or elective treatment. | Out-patient cover is often an optional add-on; does not cover routine GP visits. |
| Chronic Conditions | Critical: Does not cover pre-existing or chronic conditions. For new acute conditions only. | Does not cover treatment for pre-existing conditions unless declared and accepted. | Critical: Does not cover pre-existing or chronic conditions. For new acute conditions only. |
In short:
- Travel insurance is for when you're on holiday.
- UK PMI is for when you live in the UK.
- Cross-border PMI is for when you live and work abroad.
Why is it So Essential?
- Access to Quality Healthcare: In many countries, the quality of public healthcare can be variable. IPMI gives you access to the best private hospitals and specialists, ensuring you receive a high standard of care.
- Financial Protection: Medical treatment abroad can be incredibly expensive. A simple hospital stay for a broken leg could cost tens of thousands of pounds in a country like the USA. IPMI protects you from potentially bankrupting medical bills.
- Navigating Foreign Health Systems: A good IPMI provider offers 24/7 support lines with multilingual staff who can help you find a doctor, arrange treatment, and handle direct billing with the hospital, taking the stress out of a medical emergency in an unfamiliar country.
- Residency & Visa Requirements: An increasing number of countries now require proof of comprehensive health insurance as a condition for granting residency or work visas.
The UK Healthcare Landscape in 2026: The Role of the NHS and PMI
To understand the value of private cover, it's helpful to look at the state of public healthcare. The UK's National Health Service (NHS) is a source of national pride, providing free healthcare at the point of use for UK residents. However, it is not designed to serve expats.
NHS Access for Expats
Once you move abroad and are no longer 'ordinarily resident' in the UK, your access to free NHS treatment becomes limited.
- You are generally not entitled to routine NHS hospital treatment.
- You may be able to use NHS GP services if you are visiting the UK and your stay is temporary.
- You will always be treated in an NHS Accident & Emergency department, but you may be charged for any subsequent hospital admission.
The rules depend on your specific circumstances and the country you've moved to. Relying on the NHS while living abroad is not a viable healthcare strategy.
Persistent Pressure on the NHS
Even for UK residents, the NHS faces significant challenges. According to the latest NHS England data from 2025, the waiting list for routine consultant-led treatment remains a major concern, affecting millions of people. While figures fluctuate, the trend in the mid-2020s shows a system under immense strain. This pressure has driven many UK residents to take out private medical insurance in the UK to ensure faster access to diagnosis and treatment.
For expats, this context is doubly important. It highlights the value of having a private alternative, and it underscores the fact that the NHS cannot be a fallback option. You need a dedicated plan for your health while living overseas.
Key Features to Look for in a Cross-Border PMI Policy
Choosing the right policy can feel daunting. The best approach is to break it down and consider the key components. An expert PMI broker can be invaluable here, helping you compare complex policies side-by-side.
1. Geographical Area of Cover
This is the most fundamental choice you'll make. Insurers typically offer several tiers:
- Worldwide: The most comprehensive and expensive option, providing cover anywhere in the world.
- Worldwide excluding USA: A very popular choice. It provides global cover but excludes the USA, where healthcare costs are the highest in the world. This can significantly reduce your premium.
- Europe: Provides cover across the European continent. Ideal if you are moving to an EU country and don't plan to travel extensively outside it.
- Specific Regions/Countries: Some insurers offer plans covering regions like Southeast Asia or allow you to select a group of countries.
Top Tip: Be realistic about your travel plans. If you are certain you won't need treatment in the USA, choosing a "Worldwide excluding USA" policy is one of the easiest ways to save money.
2. Core Cover: In-patient and Day-patient Treatment
This is the foundation of any good policy. It covers the costs associated with being admitted to hospital.
- In-patient treatment: When you are admitted to a hospital bed overnight or longer. This includes surgery, accommodation, nursing care, specialist fees, and diagnostic tests.
- Day-patient treatment: When you are admitted to a hospital for a planned procedure but do not stay overnight.
Almost all cross-border PMI plans will cover this as standard. Look for plans with a high annual limit or, ideally, full cover for these costs.
3. Optional Add-on: Out-patient Cover
This is one of the most important optional extras. It covers medical treatment that does not require a hospital admission.
- Consultations with specialists and physicians.
- Diagnostic tests like MRI scans, CT scans, and X-rays.
- Physiotherapy, osteopathy, and chiropractic treatment.
- Prescription medications.
Without out-patient cover, you would have to pay for every GP visit, scan, and consultation out of your own pocket. While skipping it can lower your premium, it can lead to high day-to-day medical expenses.
4. Emergency Evacuation and Repatriation
This is a non-negotiable feature for any expat.
- Medical Evacuation: If you suffer a serious illness or injury in a location where adequate medical care is not available, this benefit covers the cost of transporting you to the nearest centre of medical excellence. This could be by air ambulance and can cost over £100,000.
- Medical Repatriation: This covers the cost of returning you to your home country for treatment if it's medically necessary and you are fit to travel.
5. The Critical Rule: Chronic and Pre-existing Conditions
This is the single most important concept to understand about private medical insurance in the UK and internationally.
PMI is designed to cover acute conditions that arise after you take out your policy. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery.
PMI is not designed to cover:
- Chronic Conditions: Illnesses that are long-lasting and cannot be cured, only managed. Examples include diabetes, asthma, hypertension, and Crohn's disease.
- Pre-existing Conditions: Any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy started.
Managing these conditions typically falls to the local public health system in your country of residence or must be funded privately. Never assume a PMI policy will cover a condition you already have.
6. Wellness, Dental, and Vision
Many modern IPMI plans from the best PMI providers now include benefits designed to keep you healthy, not just treat you when you're sick.
- Wellness Benefits: Cover for routine health checks, cancer screenings, and vaccinations.
- Mental Health Support: A growing and vital area. Many policies now offer cover for therapy, counselling, and psychiatric care, often with access to 24/7 mental health support lines.
- Dental and Vision: Usually available as a separate add-on. This can cover routine check-ups, emergency dental work, and contributions towards glasses or contact lenses.
How Underwriting Works for Expat Health Insurance
'Underwriting' is the process an insurer uses to assess your health and medical history to decide the terms of your policy. For IPMI, there are two main methods.
1. Moratorium (MOR) Underwriting
This is the most common and straightforward option. You are not required to provide your full medical history upfront. Instead, the policy automatically excludes treatment for any pre-existing conditions you've had in a set period before the policy start date (usually the last 5 years).
However, if you then go for a set period after the policy starts (usually 2 years) without needing any treatment, advice, or medication for that condition, the exclusion may be lifted, and the condition could become eligible for cover.
- Pros: Quick and easy application process.
- Cons: Lack of certainty. You may not know if a condition is covered until you make a claim.
2. Full Medical Underwriting (FMU)
With FMU, you complete a detailed health questionnaire, disclosing your entire medical history. The insurer's underwriting team will then review your application and decide on the terms. They may:
-
Accept you on standard terms.
-
Accept you but apply a specific exclusion for a declared condition.
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Accept you but charge a higher premium.
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Decline your application (this is rare).
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Pros: You have complete clarity from day one about what is and isn't covered.
-
Cons: The application process is longer and more intrusive.
MOR vs. FMU: A Simple Comparison
| Feature | Moratorium (MOR) | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Fast. No initial medical questionnaire. | Slower. Requires a full declaration of medical history. |
| Clarity on Cover | Can be uncertain. Cover for a condition is assessed at the point of claim. | Clear from the start. You receive a policy certificate detailing any exclusions. |
| Pre-existing Conditions | Automatically excluded for a set period (e.g., 2 years). | Assessed individually. May be covered, excluded, or lead to a higher premium. |
| Best For | People with a clean bill of health who want a quick start. | People with a known medical history who want certainty about their cover. |
Working with an expert PMI broker like WeCovr can help you decide which underwriting option is best for your personal circumstances.
Comparing Leading UK International PMI Providers for 2026
The UK is home to several world-leading insurers that specialise in cross-border health cover. While specific policy details and costs vary, here is a general overview of the market leaders and what they are known for.
| Provider | Key Strengths & Features | Typical Geographic Options | Ideal For |
|---|---|---|---|
| Bupa Global | Premium brand with a vast global network of hospitals. High annual limits and comprehensive benefits, including strong mental health and wellness options. | Worldwide; Worldwide ex. USA; Regional options. | Individuals and families seeking top-tier, comprehensive cover with excellent service. |
| Axa Global Healthcare | Highly flexible and customisable plans. Strong digital tools, including a virtual doctor service. Good balance of price and comprehensive cover. | Worldwide; Worldwide ex. USA/China/HK; Europe. | Expats who want to tailor their policy precisely to their needs and budget. |
| Cigna Global | Extensive experience in the expat market with a massive direct-billing network. Flexible plans ranging from essential core cover to comprehensive packages. | Worldwide; Worldwide ex. USA; Regional options. | US expats and those who value a large, established global network for easy claims. |
| Aviva | A major UK insurer with a strong international offering. Known for clear policy wording and excellent customer service. Often competitive on price for their comprehensive plans. | Worldwide; Worldwide ex. USA, Canada, & Caribbean. | UK-based expats who are familiar with the Aviva brand and want reliable, well-regarded cover. |
This is not an exhaustive list. Other excellent providers exist, and the best PMI provider for you will depend on your unique needs. This is why comparing the market is so important.
The Cost of Cross-Border PMI: What Influences Your Premiums?
The price of an international health insurance policy can vary significantly. Understanding the factors that influence the cost will help you build a policy that fits your budget.
- Age: This is the single biggest factor. Premiums increase as you get older because the statistical likelihood of needing medical treatment rises.
- Area of Cover: As discussed, a "Worldwide" policy will be more expensive than a "Worldwide excluding USA" or "Europe only" policy.
- Level of Cover: A basic in-patient only plan will be much cheaper than a comprehensive plan that includes out-patient, dental, vision, and maternity cover.
- Excess (or Deductible): This is the amount you agree to pay towards a claim before the insurer starts paying. Choosing a higher excess will lower your annual premium. For example, opting for a £500 excess instead of a £0 excess can result in significant savings.
- Underwriting: Sometimes, a policy with Full Medical Underwriting can be slightly cheaper if you are in good health, as the insurer has a clearer picture of the risk they are taking on.
- Lifestyle: Some insurers may offer lower premiums for non-smokers.
Navigating the Application Process with an Expert Broker like WeCovr
Choosing a cross-border PMI policy is a major financial decision. The policy documents can be long and full of complex jargon. You could spend days researching different providers and still not be sure if you've made the right choice.
This is where an independent and FCA-authorised PMI broker like WeCovr adds immense value.
Why use WeCovr?
- Expert, Impartial Advice: Our specialists live and breathe health insurance. We know the market inside-out and can explain the pros and cons of each policy in plain English. Our advice is always impartial, focused on finding the right cover for you.
- Market Comparison: We do the hard work for you, comparing policies from a wide range of leading international insurers to find the best cover at the most competitive price.
- No Cost to You: Our service is free. We receive a commission from the insurer if you decide to purchase a policy, but this does not affect the premium you pay. You get expert advice and support without it costing you a penny.
- Application Support: We can help you complete your application forms, ensuring all information is correct to avoid problems at the claims stage.
- Added Value: When you arrange your PMI or Life Insurance with WeCovr, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support your health goals. Furthermore, our clients often receive discounts on other types of cover, such as life or income protection insurance.
Our high customer satisfaction ratings are a testament to our commitment to providing a helpful, professional, and transparent service.
Wellness on the Go: Staying Healthy as a Global Worker
Having great health insurance is your safety net, but the best strategy is always to stay healthy in the first place. Life as an expat can be demanding, and it's important to proactively manage your physical and mental wellbeing.
Managing Jet Lag and Travel Fatigue
- Hydrate: Drink plenty of water before, during, and after your flight. Avoid alcohol and caffeine.
- Adjust Your Clock: A few days before you travel, start gradually shifting your sleep schedule towards your new time zone.
- Get Sunlight: On arrival, spend time outdoors. Natural daylight is the most powerful tool for resetting your body clock.
Eating Healthily Abroad
- Explore Local Markets: Discover fresh, local produce. It's often cheaper and healthier than relying on processed or imported foods.
- 80/20 Rule: Don't deny yourself the joy of trying new cuisines, but aim to eat healthily 80% of the time.
- Use Technology: Apps like CalorieHero, which WeCovr provides to clients, can be invaluable for tracking your nutrition and making mindful choices, even when faced with unfamiliar foods.
Staying Active
- Build it In: Choose an apartment with a gym or near a park. Walk or cycle for short journeys instead of taking a taxi.
- Find a Community: Join a local running club, yoga studio, or sports team. It’s a great way to stay active and meet new people.
- Use Your Policy: Check if your PMI plan includes wellness benefits like a contribution towards gym membership.
Managing Mental Health and Culture Shock
- Acknowledge Your Feelings: It's normal to feel overwhelmed, lonely, or anxious when in a new country. Acknowledge that culture shock is a real and temporary phase.
- Stay Connected: Schedule regular video calls with family and friends back home.
- Seek Professional Support: Don't hesitate to use the mental health support services included in your IPMI policy. A confidential call with a counsellor can make a huge difference.
Real-Life Scenarios: When Cross-Border PMI Becomes a Lifesaver
To truly understand the importance of this cover, let's look at two realistic examples.
Scenario 1: The Consultant in Dubai
- The Person: Sarah, a 45-year-old British management consultant on a one-year contract in Dubai.
- The Incident: While hiking in the mountains outside the city, she slips and suffers a serious fracture to her ankle, requiring complex surgery and metal plates.
- Without IPMI: Sarah would face a bill of over £25,000 for the surgery and hospital stay at a private Dubai hospital. She would have to navigate the billing and administration herself.
- With IPMI: She calls her insurer's 24/7 helpline. They guarantee payment directly to the hospital, so she has no out-of-pocket costs. Her policy also covers the follow-up consultations and the six weeks of physiotherapy she needs to make a full recovery. Her total covered costs exceed £30,000.
Scenario 2: The Family in Rural France
- The People: The Jones family, who have relocated from Manchester to a small village in the Dordogne region of France.
- The Incident: Their 8-year-old son, Tom, develops a severe and persistent fever with abdominal pain. The local doctor suspects a rare infection and recommends a specialist at the university hospital in Bordeaux, 2 hours away.
- Without IPMI: While they have access to the French public system, they face a long wait to see the specific paediatric specialist they need. They are worried and want a second opinion quickly.
- With IPMI: They use their plan's 'virtual doctor' service for an immediate video consultation. The virtual GP agrees with the need for a specialist. Their insurer arranges and covers a private consultation in Bordeaux the very next day. Tom is diagnosed and starts treatment immediately. The policy covers all out-patient consultations, scans, and medication.
These examples show how private health cover provides not just financial protection, but also speed of access and peace of mind when you and your family need it most.
Does my standard UK PMI policy cover me if I move abroad?
What is the difference between travel insurance and international health insurance?
Can I get international health insurance to cover my pre-existing condition?
Why should I use an expert PMI broker like WeCovr instead of going direct to an insurer?
The world of cross-border health insurance is complex, but you don't have to navigate it alone. Protecting your health and financial wellbeing while living your dream abroad is one of the most important investments you can make.
Ready to find the right health cover for your life abroad? Contact WeCovr today for a free, no-obligation quote and let our experts help you find the perfect policy.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
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