In focus: International PMI - Everybody’s talking about it

The rebranding was accompanied by an enhanced global services capability, including a 24/7 member service facility and integrated direct settlements network. Such improvements were clearly needed.

Colin Boxall, corporate director of national specialist intermediary ADVO Group, says: “We used to place quite a lot of business with Goodhealth but since the takeover we noticed a significant downturn in service and this undermined our confidence, so we haven’t placed any new business with it during 2009. The situation could have arisen as a result of a difference in attitude between the two parties as Goodhealth was very hands-on and approachable and was also able to stand back and look at the overall picture.

“But, to be fair, over the last couple of months we have noticed a lot of improvement from Aetna and this is continuing all the time. It is now putting in place managers we can actually talk to, whereas before our contacts weren’t decision-makers.”

The fact that provider spokespeople are rarely able to volunteer opinions on anything other than their own company’s progress and developments probably reflects the fact that market conditions have been so extreme that anything other than combating the economic downturn seems barely worthy of considering a trend.

However, Mark Coleman, international sales director at CIGNA International Expatriate Benefits, has noticed an increase in the utilisation of plans as employees worried about losing their jobs and finding themselves without employer-paid cover have been bringing forward claims that could otherwise have waited.

Additionally, Sarah Dennis, international healthcare director at national specialist intermediary Jelf Group, observes that she has been seeing some “shocking” rate increases. She says: “We’ve seen some insurers increase premium rates by 20% or more, reflecting rising costs of treatment throughout the world and hospitals putting their rates up. I would hope that this will slow down, otherwise we may have to look at switching at market reviews.”

One of the most noticeable differences from previous years has been the fact that commentators have fewer regulatory changes to get their teeth into. Even Dubai, which was supposed to introduce changes in January 2009, has deferred doing so. Therefore, other than the informed rumour that the United Arab Emirates (UAE) as a whole is thinking about introducing a collective regulatory system, only Germany has thrown up any news.

In January 2009 the German government introduced legislation requiring healthcare to be with a local provider. But even this move seems to have had relatively little impact on the main international PMI players. AXA PPP International is the only one specifically to flag it up. As it is not licensed as a provider in Germany it can only conduct business through the broader AXA group, which is licensed as one.

One school of thought maintains that the lack of regulatory activity, particularly in the case of Dubai, has been the direct result of governments wishing to avoid driving further costs into business during the recession. Nevertheless, no-one doubts that regulatory change will continue to be a major trend again in the future.

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