International Health Insurance
The Complete Expat Guide 2025

Most expats spend months researching visas, cost of living, and tax obligations — and then buy health insurance as an afterthought the week before they fly. That's a mistake. The wrong plan can leave you uninsured for pre-existing conditions, stranded in a local hospital that doesn't accept direct billing, or facing a six-figure repatriation bill your policy doesn't cover. This guide is the resource we wish existed when we started.

🌐 IPMI vs travel insurance — not the same thing

The most important distinction to understand: travel insurance and international health insurance are fundamentally different products.

📋 Types of international health plans

International health plans aren't one-size-fits-all. Here are the main categories and who they suit:

✅ What international health insurance covers (and doesn't)

Understanding the difference between inpatient and outpatient coverage is the most important thing you can do before buying a plan.

Inpatient (hospitalisation): Almost always included in every IPMI plan. Covers overnight stays, surgery, specialist consultations tied to a hospital admission, ICU, and emergency treatment. This is the non-negotiable core.

Outpatient: GP visits, specialist consultations, diagnostic tests, physiotherapy, and prescriptions that don't require hospitalisation. Often sold as an add-on. Without outpatient coverage, you'll pay out-of-pocket for every GP visit and blood test.

Common exclusions to watch for:

• Pre-existing conditions — conditions diagnosed or treated before your policy start date. Some insurers exclude them permanently; others apply a moratorium (typically 2–5 years symptom-free before covering them). This is the most impactful clause for most people.
• Waiting periods — most plans impose a 10–12 month waiting period before maternity benefits activate. Some have 6-month waits on certain outpatient treatments.
• Elective treatments — cosmetic surgery, experimental treatments, certain fertility treatments
• Dental and optical — almost always separate add-ons with annual limits (typically $500–2,000)
• Mental health — increasingly included, but read the sub-limits carefully. Some plans cap at 30 sessions per year.
• US coverage — US treatment is catastrophically expensive. Many international plans either exclude the US entirely, or include it at a dramatically higher premium. If you might need to travel to the US for treatment, check this explicitly.
• High-risk activities — scuba diving, mountaineering, motorcycling — may require a specific rider

🔍 Pre-existing conditions — what you need to know

This is the section most people skip and later regret. How insurers handle pre-existing conditions varies enormously, and the approach affects both your premium and your actual coverage.

Three main underwriting approaches:

• Full Medical Underwriting (FMU): You disclose your full medical history upfront. The insurer reviews it and explicitly lists what is and isn't covered. You get certainty — you know exactly what's excluded before you sign. Recommended for anyone with significant health history.
• Moratorium Underwriting: No upfront health questionnaire. Instead, any condition you had symptoms of in the last 5 years is automatically excluded for the first 2 years of the policy. After 2 continuous years on the plan without symptoms or treatment for that condition, it becomes covered. Cheaper upfront, less paperwork, but more uncertainty at claim time.
• Continued Personal Medical Exclusions (CPME): Used when switching providers — your previous exclusions carry over. Protects you from being underwritten again from scratch.

🤱 Maternity coverage

If you're planning a family abroad, maternity coverage deserves its own research. The rules are strict and the waiting periods long.

• Standard waiting period: 10–12 months from policy start before maternity benefits activate. This means you need to buy a plan with maternity coverage at least a year before you plan to conceive.
• What's typically included: Prenatal consultations, ultrasounds, delivery (vaginal and caesarean), postnatal care, complications of pregnancy
• What's typically excluded: Fertility treatment, IVF, elective terminations, newborn care beyond the first days (baby needs their own policy)
• Annual limits: Many plans cap maternity at $5,000–15,000 per pregnancy — check whether this is realistic for your host country's private hospital costs
• Providers strong on maternity: Cigna Global, Allianz Care, AXA Health — all have dedicated maternity modules with reasonable annual limits

🚁 Medical evacuation and repatriation

Medical evacuation is the coverage that feels least necessary — until it is. A fixed-wing air ambulance from Southeast Asia to Europe costs $50,000–120,000. From Latin America to the US, $30,000–80,000. Without coverage, this bill falls entirely on you.

Key terms to understand:

• Medical evacuation: Transport to the nearest appropriate medical facility — not necessarily your home country. Kicks in when local care is inadequate for your condition.
• Repatriation: Transport back to your home country for treatment or recovery, including after stabilisation. Usually requires insurer authorisation.
• Mortal remains repatriation: Covers the cost of returning remains to your home country in the event of death abroad. Morbid but important — costs can exceed $10,000.
• Companion travel: Some plans cover a family member's travel to be with you during hospitalisation abroad.

🏢 Major providers compared

The international health insurance market is dominated by a handful of large insurers. Here's an honest assessment of the main players in 2025:

💰 How much does it actually cost?

Premium varies significantly based on your age, health history, region of coverage, plan type, and deductible. Here are realistic estimates for a single adult in good health:

Ways to reduce your premium:

• Choose a higher deductible (excess): An annual deductible of $500–2,500 can reduce premiums by 20–40%. Good option if you're healthy and want catastrophic coverage rather than routine coverage.
• Exclude the US: Adding US coverage can increase premiums by 50–100%. If you don't plan to seek treatment in the US, removing it saves significantly.
• Buy inpatient-only and pay GP visits out of pocket: In countries where a GP visit costs $20–50, self-funding routine outpatient care and insuring only for serious illness is often better value.
• Use a broker: Independent brokers (like Pacific Prime or William Russell) can compare plans across providers and negotiate rates — at no extra cost to you, as they're paid by the insurer.

🎯 How to choose the right plan

Work through these questions in order before buying:

1. Where will you live? Local private insurance in a country with good private healthcare (Portugal, Spain, Germany) can be far cheaper than a global IPMI plan — and sufficient if you're not moving frequently.
2. How long are you staying? Under 6 months and healthy → nomad plan. 1–2 years → IPMI inpatient minimum. Long-term / permanent → full IPMI or local plan depending on country.
3. Do you have pre-existing conditions? Yes → choose Full Medical Underwriting so you know exactly what's covered from day one. No → moratorium is cheaper and simpler.
4. Are you planning a family? Yes → buy maternity coverage now, before you conceive, to satisfy the 10–12 month waiting period.
5. Will you need US coverage? If yes, factor in the significant premium increase and check annual limits carefully — a US hospital stay can exhaust a $1M annual limit.
6. Does your host country require specific insurance? Some visa types (D7 Portugal, D8, many EU visas) require proof of health insurance as part of the application. Check whether a nomad plan meets the minimum criteria — it often doesn't.

📝 Before you buy — checklist

• Confirm your domestic insurance void date for long-term stays abroad
• Check whether your visa application requires specific coverage amounts
• Decide between FMU and moratorium based on your health history
• Confirm whether your plan covers the country you're moving to and any countries you'll visit
• Check the direct-billing hospital network in your destination city
• Read the pre-existing condition clause — specifically the moratorium period if applicable
• Check the annual inpatient limit (aim for €1M+ minimum)
• Confirm evacuation and repatriation are included
• If planning a family: verify maternity waiting period and annual limit
• If you might visit the US: confirm US coverage and any sub-limits
• Understand the claims process before you need it — app, hotline, or portal?

This guide is for informational purposes only. Insurance products, coverage terms, and premium rates change frequently. Always read the full policy wording before purchasing, and consult an independent insurance broker for advice tailored to your specific health situation and destination. Provider information is based on publicly available data as of early 2025 and may not reflect current offerings.