TL;DR
In today's globalised business environment, sending your talent abroad is no longer a rarity—it's a strategic necessity. At WeCovr, where our experienced team has helped arrange over 900,000 policies of various kinds, we understand that protecting your employees' health, wherever they are in the world, is paramount. This guide demystifies Group International Private Medical Insurance (IPMI), your essential tool for ensuring your expatriate team receives first-class medical care.
Key takeaways
- IPMI is not travel insurance. Travel insurance is for short-term trips and focuses on medical emergencies, lost luggage, and travel disruption. It is not designed for routine healthcare or long-term residence abroad.
- IPMI is not domestic UK PMI. A standard UK private medical insurance policy is geographically limited to the UK. It will not provide cover for an employee who has relocated to Dubai, Singapore, or New York.
- A British national sent to work in your company's German office.
- An American citizen hired to work for your UK-based company in South Africa.
- A 'global nomad' who moves between various international assignments.
In today's globalised business environment, sending your talent abroad is no longer a rarity—it's a strategic necessity. At WeCovr, where our experienced team has helped arrange over 900,000 policies of various kinds, we understand that protecting your employees' health, wherever they are in the world, is paramount. This guide demystifies Group International Private Medical Insurance (IPMI), your essential tool for ensuring your expatriate team receives first-class medical care.
A detailed employer guide – eligibility, underwriting, benefits design, employer vs employee contributions, renewals and administration
Navigating the world of international health cover can seem daunting. Unlike domestic UK private medical insurance, IPMI is designed for the unique challenges of living and working abroad. This comprehensive guide will walk you through every critical aspect, from setting up a policy to managing it effectively, ensuring you can make informed decisions that benefit both your employees and your organisation.
What is Group International Private Medical Insurance (IPMI)?
Group International Private Medical Insurance is a specialised health insurance plan designed for organisations with employees working outside their home country for an extended period (typically one year or more). It provides comprehensive medical cover across different countries and healthcare systems.
Crucially, IPMI is distinct from both domestic private health cover and standard travel insurance.
- IPMI is not travel insurance. Travel insurance is for short-term trips and focuses on medical emergencies, lost luggage, and travel disruption. It is not designed for routine healthcare or long-term residence abroad.
- IPMI is not domestic UK PMI. A standard UK private medical insurance policy is geographically limited to the UK. It will not provide cover for an employee who has relocated to Dubai, Singapore, or New York.
Group IPMI bridges this gap, offering peace of mind that your expatriate team has access to high-quality healthcare, from routine GP visits to complex hospital procedures, no matter where their assignment takes them.
| Feature | Group IPMI | Domestic UK PMI | Travel Insurance |
|---|---|---|---|
| Primary Purpose | Comprehensive healthcare for long-term expatriates | Supplementary healthcare within the UK | Emergency cover for short-term trips |
| Geographic Scope | Global or specified regions, excluding home country | Primarily UK only | Worldwide, for a limited trip duration |
| Cover Level | In-patient, out-patient, wellness, dental, maternity | Primarily acute conditions, in-patient & out-patient | Emergency medical treatment & repatriation |
| Duration | Annual, renewable policy for long-term residence | Annual, renewable policy | Per-trip or annual multi-trip (max 30-90 days per trip) |
| Chronic Conditions | Can be covered under certain underwriting terms | Generally excluded | Almost always excluded |
Who is Eligible for Group IPMI? The Basics for Employers
Defining who can be included in your group scheme is a foundational step. Insurers have specific criteria that employers must meet.
1. Minimum Group Size: Most insurers require a minimum number of employees to establish a group scheme. This is typically three to five employees, though some may consider smaller groups. The larger the group, the more negotiating power you have, particularly regarding underwriting terms.
2. Defining an 'Expatriate': An expatriate is generally defined as an employee (and their dependants) living and working outside of their country of nationality for a prolonged period. This includes:
- A British national sent to work in your company's German office.
- An American citizen hired to work for your UK-based company in South Africa.
- A 'global nomad' who moves between various international assignments.
3. Dependant Eligibility: One of the key benefits of a group scheme is the ability to extend cover to your employees' families. Eligible dependants typically include:
- Spouse or legal partner.
- Unmarried children, often up to the age of 18, or up to 24 if they are in full-time education.
Providing cover for families is a powerful tool for employee retention and can be critical for the success of an international assignment.
The Crucial Role of Underwriting in Group IPMI
Underwriting is the process an insurer uses to assess risk and decide whether to offer cover, on what terms, and at what price. For group IPMI, the underwriting method is arguably the most important decision you will make.
Key Point: Standard private medical insurance in the UK does not cover chronic or pre-existing conditions. IPMI, especially on a group basis, offers more flexible options that can address this.
Here are the main types of underwriting for group schemes:
1. Medical History Disregarded (MHD)
This is the most comprehensive and desirable form of underwriting.
- What it is: The insurer agrees to cover all eligible medical conditions, including pre-existing ones, for all members of the group.
- How it works: Employees do not need to complete any medical questionnaires. Cover is automatic.
- Eligibility: Typically available for groups of 10 or more employees, though an expert broker like WeCovr can sometimes negotiate MHD terms for smaller groups.
- Benefit: It eliminates administrative hassle and ensures all employees have full cover from day one, which is a major benefit for morale and duty of care.
2. Continued Personal Medical Exclusions (CPME) / Switch Underwriting
This is used when your company is switching its IPMI provider.
- What it is: The new insurer agrees to match the underwriting terms of your previous policy. Any exclusions that applied to an employee under the old policy will be carried over to the new one.
- How it works: It provides continuity of cover and prevents new exclusions from being applied for conditions that developed while covered under the previous insurer.
- Benefit: Makes switching providers seamless for employees, as their cover level remains consistent.
3. Full Medical Underwriting (FMU)
This is common for very small groups (fewer than 5 members) or individuals.
- What it is: Every employee and dependant must complete a detailed medical history questionnaire.
- How it works: The insurer's medical underwriters review the information and may apply specific exclusions for pre-existing conditions or even decline cover for certain individuals.
- Drawback: It is administratively burdensome and can result in unequal or incomplete cover for your team, potentially creating duty-of-care issues.
4. Moratorium Underwriting
While more common for individual policies, it can be an option for small groups.
- What it is: Pre-existing conditions from a set period (usually the 5 years before the policy starts) are excluded for an initial period (usually 24 months).
- How it works: If an employee goes for 24 consecutive months without experiencing symptoms, seeking treatment, or receiving advice for that condition, it may become eligible for cover thereafter.
- Drawback: It creates uncertainty. Employees may not know if a condition is covered until they need to make a claim.
Broker Insight: For any group of a reasonable size, always push for Medical History Disregarded (MHD) underwriting. It offers the cleanest, fairest, and most comprehensive cover. A common mistake employers make is accepting FMU for a growing team, leading to administrative headaches and unhappy employees down the line.
| Underwriting Type | Best For | Pre-existing Conditions | Employee Admin |
|---|---|---|---|
| MHD | Groups of 10+ employees | Covered from day one | None |
| CPME (Switch) | Groups switching insurer | Covered if they were covered before | Minimal |
| FMU | Very small groups (2-3) or individuals | Assessed and often excluded | High (detailed medical forms) |
| Moratorium | Small groups where MHD isn't possible | Excluded for 2 years, then potentially covered | Moderate (claim-time checks) |
Designing Your Group IPMI Benefits Package
IPMI policies are typically structured in a modular way, allowing you to build a plan that matches your budget and your employees' needs.
Core Cover: In-patient and Day-patient Treatment
This is the non-negotiable foundation of any IPMI plan. It covers treatment that requires a hospital bed.
- Hospital accommodation and nursing care
- Surgeons', anaesthetists', and specialists' fees
- Advanced diagnostic imaging (MRI, CT, PET scans)
- Cancer treatment (chemotherapy, radiotherapy)
- Medical evacuation and repatriation (often a core benefit in IPMI, this is vital for employees in remote locations)
Optional Add-on: Out-patient Cover
This is the most popular addition and covers treatment that does not require a hospital bed.
- Consultations with specialists and GPs
- Prescription drugs and dressings
- Diagnostic tests and X-rays
- Physiotherapy, osteopathy, and chiropractic treatment
Insider Tip: While excluding out-patient cover can significantly reduce premiums, it can lead to employees delaying seeking treatment for minor issues, which could then escalate into more serious (and costly) in-patient conditions. A plan with a sensible out-patient limit is often the most cost-effective solution in the long run.
Other Common Modules
- Dental and Vision: Covers everything from routine check-ups and cleanings to major restorative work and prescription eyewear.
- Maternity Cover: Provides cover for routine and complicated pregnancies and childbirth. This usually comes with a waiting period of 10-12 months before benefits can be claimed.
- Wellness Programmes: Proactive health benefits like health screenings, vaccinations, and gym membership contributions.
- Mental Health Support: A crucial and increasingly popular benefit, offering access to counsellors, psychologists, and psychiatrists.
Employer vs Employee Contributions: Funding Your Scheme
Deciding how to fund the IPMI scheme is a key strategic decision.
-
Employer-Paid (Compulsory): The most common approach. The company pays 100% of the premium for all eligible employees. This maximises the benefits of group underwriting (like MHD) and is a powerful tool for attracting and retaining top international talent.
-
Cost-Sharing / Co-payment: The employer pays a percentage of the premium (e.g., 80%), and the employee pays the remaining 20%. This can help manage costs while still providing a valuable, subsidised benefit.
-
Employee-Paid (Voluntary): The employer facilitates the group scheme, but employees opt-in and pay the full premium themselves. This is less common as it loses the "employee benefit" appeal, but it can still provide employees with access to better rates and terms than they could get as individuals.
Tax Implications for UK-based Employers
It is essential to understand the tax treatment of IPMI in the UK.
- Benefit in Kind (BIK): For employees who are UK taxpayers, employer-paid IPMI is considered a 'Benefit in Kind'. This means it has a cash value that is subject to income tax for the employee.
- P11D Form: As the employer, you are responsible for calculating the value of the benefit and reporting it to HMRC for each employee on a P11D form at the end of the tax year.
- National Insurance: The company will also have to pay Class 1A National Insurance contributions on the value of the benefit.
Plain English: The cost of the health insurance premium paid by the company is treated as extra salary for the employee, and they pay tax on it. The company also pays a National Insurance tax on that amount. Always consult with your accountant to ensure correct reporting.
The Renewal Process: What to Expect Each Year
Your IPMI policy will be due for renewal annually. You will typically receive your renewal terms from the insurer 6-8 weeks before the expiry date. This document will outline the premium for the upcoming year.
Factors Influencing Renewal Premiums:
- Medical Inflation: The rising cost of healthcare in the countries where your employees are based. This is often the biggest driver of premium increases and can range from 7% to 15% globally per year.
- Group Claims Performance: If your group has made a high value of claims in the preceding year, your premium is likely to see a significant increase. Conversely, a low-claim year can help moderate increases.
- Ageing Workforce: As the average age of your group members increases, the underlying risk and therefore the premium will rise.
- Changes to Benefits or Location: Adding more comprehensive benefits or moving employees to high-cost countries (like the USA or Switzerland) will increase the premium.
Broker Insight: Never simply accept your insurer's first renewal offer. The renewal period is the best opportunity to reassess the market. At WeCovr, we conduct a full market review for our clients every year, comparing the renewal terms against other leading providers to ensure you are still getting the best value and cover. This proactive approach can save businesses tens of thousands of pounds.
Administration and Claims: Making the Policy Work
A great policy is only effective if it's easy to use.
Employer Administration: Your role as the administrator will involve:
- Managing Membership: Adding new employees and their dependants to the scheme.
- Processing Leavers: Removing employees who leave the company.
- Updating Details: Informing the insurer of any changes, such as a change in an employee's country of residence.
- Liaising with your Broker: Using your broker as the first point of contact for queries and support.
The Employee Claims Experience: The claims process is a critical 'moment of truth' for your employees.
- Pre-authorisation: For any planned hospital treatment, the employee (or hospital) must contact the insurer for pre-authorisation. The insurer confirms the treatment is covered and arranges payment.
- Direct Billing (Cashless Access): For in-patient and often out-patient treatment, the insurer will have a network of medical providers they can pay directly. The employee simply shows their insurance card and does not have to pay out-of-pocket.
- Pay and Claim (Reimbursement): For some out-patient services or treatment outside the direct billing network, the employee may need to pay upfront and then submit the receipt to the insurer for reimbursement via an online portal or mobile app.
A top-tier IPMI provider will offer 24/7 multilingual support to help employees find doctors, pre-authorise treatment, and navigate local healthcare systems.
Final Thoughts: Your Partner in Global Health
Providing robust International Private Medical Insurance is a cornerstone of a successful global mobility programme. It demonstrates a profound commitment to your employees' wellbeing, protects your business from unforeseen costs, and provides a significant competitive advantage in the hunt for global talent.
The market is complex, but the principles are clear: secure the right underwriting, design a balanced benefits package, and actively manage your policy year on year.
Navigating this landscape alone can be challenging. Partnering with a specialist broker like WeCovr gives you access to market-wide expertise, negotiating power, and dedicated administrative support, all at no extra cost to your business. We help you compare the UK's best IPMI providers to find a solution that fits your people and your budget. As a WeCovr client, you also get complimentary access to our AI-powered calorie tracking app, CalorieHero, and can benefit from discounts on other business and personal insurance policies.
Ready to protect your global team? Contact us today for a no-obligation quote and a free review of your international health insurance needs.
