FAQ/Wikisurance

Collective insurances (for groups) can often be cheaper, but are linked to strict rules.

Please also read the part about adverse selection (above) to have a better understanding of why there are such strict rules in collective policies.

Collective policies limit the individual choices of the members. Just as in a football team everyone has to wear the same shirt, members of a collective insurance all have the same coverage, without much possibility of opting out.

The description of who is eligible to enter the group is made by the head of the group (often the HR-manager) in an objective way. There is no possibility to discriminate on gender or other personal characteristics, or to favour a certain person.

So, the idea of giving persons with an unhealthy set of teeth extra dental cover is not possible in a collective insurance. All group members have the same coverage. Those eligible for cover are described objectively (e.g. all staff members with more than 5 years of service, all expats in area X, all managers of level Y and above,...). Everyone new who fits in with the set of conditions, has to join the collective insurance.

If you want to have more free choice then you shouldn't choose a collective plan, but opt for an individual plan instead (more individual choice, but also more expensive).

Social security is a program of covers (health, disability, unemployment, etc…) funded, regulated and guaranteed by the government. In some countries (parts of) the program is fully organised by private insurance companies, but it is always strictly regulated by the government. All policies have exactly the same conditions (occupational accidents in Belgium, health in Switzerland and the Netherlands). But in most countries social security is managed by public institutions.

On the other hand, privately owned companies have their own systems to fill the gaps left by social security or to provide an alternative. Private companies have their own conditions, all different from each other, but they will all be compliant with the insurance acts and (inter)national laws.

Social security has no problems due to adverse selection as they cover the whole population on the same conditions. The only instance of adverse selection they might face is from possible immigrants coming to their countries just because of, and to abuse, the local social security.

Private insurers are not so lucky as they insure individual clients. Here adverse selection is a major problem. You'll never find medical questionnaires, individual exclusions or premium loadings in social security. You’ll only find them with private insurers who wish to ensure their clients are offered a fair and interesting premium that is directly related to their individual risks.

A chameleon adapts to the situation he is in. In a green environment he becomes green, in a brown environment he changes into brown. In health insurance land you also have two main systems:

• In some countries there is no social cover or a care-in-kind cover (free treatment, but no free choice of doctors and long waiting periods).
• In other countries you are completely free to choose the doctor or hospital you visit, but you have to pay the doctor yourself and claim a reimbursement back from social security later on.

Private health insurances follow the system of social health cover in the country they operate in. In countries with no social health cover or a care-in-kind cover, private health insurance companies provide a 1st € insurance (or “full cover” insurance) to compensate for the lack of cover or as an alternative to the lower quality of social cover.

In countries with a pay-and-claim system (or reimbursement system), health insurers “top up” the local social security as they never cover the full 100% of treatment.

Chameleon Principle based insurances can switch from “top-up” insurance to “full cover” insurance, and vice-versa, within the same policy.

Some health insurers provide a double solution: a health insurance that acts as a top up to the home country social security and a full cover health insurance for abroad. These policies will not have the same terms and conditions for national and international coverage.  This is what sets health insurance policies based on the Expat & Co Chameleon Principle apart from other insurances. The E&C° Chameleon Principle policies can switch from one system to the other without changing any of the general conditions. E&C° can top up all 15 different reimbursement systems* worldwide, and offers full cover elsewhere. That makes E&C° unique in the world.

And we go even further. Thanks to our "sleeper" mode the client can temporarily stop his coverage (e.g. when he enjoys coverage by his employer), and restart it when needed.

*Countries with reimbursement systems: AT, BE (riziv/inami), BE (dibiss/orpss), CH, CZ, DE, EE, FR (cmu/cpam), FR (cfe), IL, JP, LI, LU, NL and the EU-officials system (rcam/jsis).

This means we are the only health insurer in the world that can guarantee the expat a lifelong continuity of cover, without losing any coverage (due to exclusions) during all changes of health insurer.

Our solution fits in every country of the world, and prevents you having to pay overlapping premiums in reimbursement countries. To us, it makes no sense to have a full cover insurance if your social cover already reimburses 75% or more. Why would you pay for 2 insurances if you can have one that just fills the gaps to the other?

You can find out more about social systems around the world, and about our Chameleon-Principle by watching our movies or visiting this page.

Expat & Co is licensed to sell insurances in all countries of the European Economic Area. This means we always need a European link:

• you are a European concluding/taking out your insurance in Europe;
• you are a non-European residing in Europe and concluding/taking out your insurance in Europe;
• you work for a European employer who concludes/takes out the insurance in Europe;
• anyone who takes out a E&C° policy may choose to keep it for the rest of their life (except when mentioned otherwise in the policy conditions) and can take the policy with them, wherever they travel or move to next.

We accept all nationalities and all destination countries as long as these rules are followed.

Online policies are considered to have been taken out at the head office of Expat & Co° in Belgium (Europe).

Europat Insurance policies can be extended/renewed lifelong.

Student Insurances can be extended/renewed as long as the insured is a student or a university staff member (linked to a school or university). Au-pairs can extend/renew for as long as they are working as an au-pair (≠ nanny). Please see the definition of au-pair below in our FAQ.

Globi Insurances can be extended/renewed until the insured person reaches the age of 75 years.

Schengen Travellers Insurances can only be taken out for a maximum of 90 days at a time, because a Schengen visa is also limited to 90 days. There is no age limit.

Business Travellers Insurances can be extended/renewed for as long as the insured members work for the organisation. Individual policies end at the age of 80.

The policy can be cancelled by written termination letter sent by registered post:

• on Due Date with at least 3 months prior notice;
• in connection with a claim, within 30 days after the Company has taken a final position;
• in connection with a premium increase or alteration of conditions.

In case of death of the Policy Holder, the eventual other Insured Persons can terminate the contract by sending a registered letter within 30 days after death.

Can I cancel my policy when I move to another country? No, your policy is built according to the Chameleon Principle, which means it adapts to your new situation of country and social security.

Can I cancel my policy when I move back to my home country? Again, your policy can adapt to all new countries. But if you don’t need the insurance anymore because you can enjoy your home country social security and other local benefits, you have two possibilities: cancel the policy or keep the policy in Sleeper mode. The advantage of keeping your policy in Sleeper mode is that when you expatriate again, you can restart your policy without medical underwriting (medical questionnaire). This way you don’t risk being faced with new exclusions.

Can I cancel my policy to go to another health insurer that seems better/cheaper? Only by following above mentioned cancellation procedure.

• In the USA: please contact Roberta Jimenez at Olympus (+ 1 305-459-4838 or rjimenez@omhc.com). She will guide you through the procedure to get an appointment with a doctor or hospital.
  You can find a list of doctors on: www.omhc.com/Page/Search
• Outside the USA: you have absolute free choice of doctor and/or hospital.

What if I have to be admitted to hospital?

Call or e-mail the Alarm Centre for immediate support.
Tel: +32 (0)2 669 0880 24/7 E-mail: help@expatinsurance.eu  (24/7).
PLEASE DO NOT CONTACT THE ALARM CENTRE JUST FOR INFORMATION ABOUT YOUR POLICY OR CLAIM. For information regarding policies please contact info@expatinsurance.eu, and regarding claims contact claims@expatinsurance.eu.

If you are, or have to be, admitted to hospital in the USA, please contact Roberta Jimenez at Olympus (+ 1 305-459-4838 or rjimenez@omhc.com). She will guide you through the procedure for admittance, and she will negotiate the best prices on your behalf.

Health care in the USA is enormously expensive, and the system is different from European countries. Prices are set to commercial tariffs. Negotiating on prices is usual and so is overconsumption. Hospitals are not, as in most European countries, non-profit organizations.

A simple doctors’ consult will cost about 150 to 300 USD.

A hospital room can cost up to 50.000 USD for 4 days, but can be negotiated down to 10.000 USD or less.

Free choice of doctors/hospital in USA (the land of freedom) is an utopia. Lots of doctors are tied to a single insurer. If you don’t have the right insurance card they will refuse to treat you. Other doctors do not work with insurers, so they won’t accept your insurance card either.

This is why we feel it is better to work with a network. We chose the Olympus network because they combine several insurer networks to make one big network. This gives our clients a bigger (though not unlimited) choice. 

Olympus will negotiate prices (upfront) with the doctors/hospitals on your and our behalf and can negotiate price reductions between 20 and 90%. If you have a co-pay you too will profit from the lower prices they negotiate so it is in all our interests to have all appointments and arrangements in the USA go through Olympus.

Thanks to these price reductions we can keep our insurance premium affordable.

If you do not follow the Olympus instructions we will be forced to increase your annual premium (due to the higher cost) and/or we may ask you to take an extra co-pay of 20% of the real cost.

We always strive to settle a claim correctly following the general conditions. These general conditions are made to set the rules. We can not deviate from these rules. For all your questions and problems concerning claims settlements make sure to talk to Expat & Co first.

If the problem can’t be solved by Expat & Co, any complaints can be submitted to the Ombudsman Insurances, de Meeûssquare 35, 1000 Brussels.
tel. +32 (0)2/547.58.71
fax. +32 (0)2/547.59.75
info@ombudsman.as
www.ombudsman.as

Expat & Co also has a policy in case of conflict of interest. You can find it here:

Conflict Of Interest

Also note that if you don’t agree with a claim settlement you have the right to cancel your policy within 30 days after the Company has taken its final position.

A deductible, also known as ‘excess’ is the real out-of-pocket-expense, as listed in the Policy Schedule or Benefits List, which will be deducted from the reimbursement to the Insured Person.
For medical expenses this deductible will be applied annually.
For other guarantees this deductible will be applied per claim.

A co-pay or co-insurance is the percentage of the expense, as listed in the Policy Schedule or Benefits List, which will be deducted from the reimbursement to the Insured Person.

This co-insurance will be applied per claim.

A deductible of co-pay cannot be claimed back.

Why do I receive a premium loading or moratorium?
Premiums are calculated based on a normal healthy person. Persons with pre-existing medical conditions have more medical expenses. This is a certainty.

As previously discussed (see question: What is an insurance?) certainties can’t be insured. So, insurers exclude it.

 Compare it with other insurances:

• Can you buy a fire insurance when your house has burnt down? No. Only after it has been rebuilt.
• Can you buy a fully comprehensive  insurance for your car if it has scratches? Yes, but only with the exclusion of the existing scratches, or after repairing it.

•  higher risks (not certainties) may incur a premium loading;
• existing incurable diseases are always excluded;
• existing curable conditions can have a moratorium, in which case you should be symptom free before you can be insured.

It’s quite normal that if you go abroad that you may need certain vaccinations. These vaccinations are part of the normal preparatory actions you take before departure. It is not an unexpected expense, if you have prepared well.

As an insurance only covers the non-expected expenses, normal preparatory treatments are not reimbursable, even after departure. To avoid discussions we have foreseen a waiting period.

Vaccinations often need a renewal. These renewals are covered in policies that cover medical preventative costs (Europat Insurance, Globi Insurance). These are not covered in policies where we only cover medically necessary costs (Student Insurance, Business Travellers Insurance, Schengen Travellers Insurance).

Please note that children and students in the USA must be vaccinated before entering school or university. For new clients these vaccinations are not covered, as they form part of your travel preparations (waiting period of 3 months after start of the policy).

A Disability Pension or Income Protection Insurance has the following characteristics:

• Eligibility (who can take out such a policy?): normally only persons with a professional income, up to a certain age. Expat & Co accepts persons up to the age of 55.
  As some spouses/partners have to take a career break to follow their partner abroad, they also lose their possibility to have an income protection insurance, as they lose their income. Therefore Expat & Co has decided to accept temporarily non-working spouses for income protection insurance. After all, should something happen, they wouldn't be able to maintain their standard of living, simply because they followed their life partner abroad.
  In order to avoid that every non-working spouse/partner would take out income protection insurance, they must prove that they still were working 2 months before they left the country.
• Every income protection insurance has a maximum insurable pension, in order to avoid that not working would become more interesting than working.
  For Expat & Co the maximum insurable pension is calculated as following:
  • 80% on the first bracket of 50.000€ gross annual income (without allowances);
  • For the next bracket above 50.000€ we take 60% (or 50% if the income is variable, e.g. bonus-based);
  • The absolute maximum annual income we will insure is 100.000 €.
• You can choose a waiting period of 30, 60, 90, 180, 365 or 730 days after the incident. This means that during this period there is no compensation for the loss of income.
• The following risks are covered:
  • accident;
  • illness;
  • sometimes also pregnancy complications (of course women only). This is also the case for the Expat & Co policy.
• Disability is determined based on:
• physical disability;
• sometimes also economic disability (what is the impact on your earning power).
  Each insurance company has their own way of calculating your monthly compensation, by using one or the other, or a combination of both kinds of disability. And this can make an important difference.
  For example: a concert pianist loses his little finger. If a company only looks at the physical disability it would lead to a disability of 5%. But when we look at the economical disability it would be 100%, because he can’t play the piano anymore.
  Expat & Co pays highest of both. So, for the pianist it would be 100%, until he can learn to play another instrument where he doesn’t need that little finger.
• Payment of Disability Pension: this differs from company to company and is determined in the general conditions, some start at 25%, others at 33% or 50% and for some you need to be fully (100%) disabled before being eligible for the pension. Some insurers increase their compensation when you have a higher disability grade or add an extra one-time-only lump sum.
  Expat & Co pays as follows:
  • between 0-25%: no payment, because you still receive 75% income;
  • disability between 25 and 66%: proportional payment (e.g. 50% disabled = 50% payment);
  • As from 67% disability we pay 100% of the insured pension.
• Sometimes companies will reimburse a part of the premium you have to pay. It is called ‘waiver of premium’. As long as you are compensated for your (temporary) disability you are not required to pay this section of your premium. The waiver of premium is proportional to the same percentage as payment of the pension.
• In case of long-term disability the pension may increase annually, like a type of index which helps keep your income level with the cost of living.  Expat & Co's Disability Pension grows by 2% of the insured amount every year. For the non-working spouse the pension is kept constant.
• End of the policy depends on the company. You can take out a policy for a few years or until retirement age. The Expat & Co Disability Pension policy ends at 60 years, but keeps on paying until you reach the age of 65, if you are disabled before 60.