Supporting the Globalization Initiative
Crafting a Global Health
New Offshore Paradigm
By Tamara Stephenson
Insured Benefits Practice Leader
Notes From Our Client Files:
NEW BUNDLE OF JOY
one of our systems clients Martha was a key contributor to their new Argentina
operation. Technically excellent and a top client manager, Martha was
the spark plug of a major new business initiative; the Argentina partner
wanted no one else on the case. And Martha was looking forward to returning
to the United States in a couple of months for the birth of her first
a rainy night in May, Martha rushed from her hotel to the Buenos Aires
hospital suggested by the doorman. Clearly the baby was on the way. At
the hospital the staff was concerned and solicitous and gave her a comfortable
seat in the lobby until she could demonstrate to them some form of guaranteed
payment. Waving her US medical card provoked puzzled looks, and her VISA
balance just wasn’t up to the task.
Martha woke her Executive VP in the US, and she woke the head of HR from
a deep sleep, the fun potential of the situation had evaporated.
JUST A LITTLE TWINGE
had noticed a little stomach discomfort on his flight from Frankfurt to
Hanoi. Nothing to be concerned about, what with a major hardware sale
in the offing … until his appendix made its presence known at the
conference table. His strategic partners made the decision and he was
rushed to a local doctor who sent him to the local hospital. Gunther called
his employer from the gurney where he was being prepped for surgery …
but no one in Hanoi medical practice had as yet spoken to him in a language
he could understand. Great faith is a blessing, but Gunther had a need
to know what they were planning to cut out of him….
and it was several weeks before it was discovered that Gunther’s
German Opt-Out health coverage had no foreign treatment coverage provision.
The Emerging Global Dynamic
successful organization today is more global than ever in orientation.
of this new environment is that
market products sales and marketing are critical to business development
more than ever.
outsourcing of a wide variety of company functions … from call
center and customer service to research and development … has
become a competitive necessity.
frozen hiring budgets and “make do with what you have”
a consistent theme, companies are more and more sending trained executives
and staff on short or long term assignments to foreign locations as
a cost effective alternative to adding new staff
companies need to utilize US and foreign employees (Third Country
Nationals/TCN’s) in foreign country locations on an immediate
basis. Often these employees are in a foreign location (perhaps with
accompanying spouses or dependents) long before Human Resources and
Employee Benefits staffs become aware of the fact.
are sent “as they are”, without extensive regard to medical
service needs or pre-existing medical conditions.
and more experienced staff is being assigned for longer periods for
such purposes as startup of outsourcing operations, training of local
country national employees, and developing new markets.
Global Coverage Challenge
multinational employer is confronted with two important and related global
medical plan needs.
emergency medical coverage for business travel and short term assignments.
comprehensive home country level health coverage plan for employees
and dependents who are on long term assignment in foreign countries.
US or home country health plan usually falls short in a number key areas
in meeting these needs.
these plans, if they cover foreign treatment at all, do so on a reimbursement
basis. This leaves the employee or the employer to pay the bill up
plans provide little or no assistance in selecting a medical provider
in a foreign location. “Heart specialist by Yellow Pages”
can be an exciting experience.
less developed countries become more attractive locations to companies,
medical evacuation becomes more of an issue. Home country plans generally
do not provide this service.
little things can kill you. A traveling executive who is spending
most of the visit finding the local equivalent of a needed US prescription
drug can slow down the deal. Home country plans are usually no help
the Global Solution
comprehensive solution involves two distinct, but allied programs
short term Business Travel accident program for the short term traveler
and assignee, and
long term comprehensive program meeting the complete needs of expatriates
programs must have the important features of
short term Business Travel Accident program must have the features of
Coverage – Enrollment by name just isn’t an option.
No one is going to remember to tell the Benefits Group that Joe will
be in Iceland for a week or two.
– The system must be seamless and supportive of the traveler.
Maybe the home country plan can bury the employee in forms, but the
traveler needs to make one call and get results.
and Reasonable Duration – Just because we thought Rashid
would be in the US for two weeks doesn’t mean he won’t
be needed there for four months. Short duration plans can defeat the
and Dependent Coverage – Company policy not withstanding,
spouses to do get to go along more than we believe. “She isn’t
supposed to be there.” isn’t the productive response needed
to a foreign emergency situation.
When your employee is on a business trip to Switzerland, telling her
that her skiing accident is not covered as “diversion and frolic”
means you have the wrong plan.
– For the employee booking a flight home through Pakistan or
Turkey, or London for that matter, authoritative and immediate security
updates are more than a reassuring extra.
The long term Expatriate/TCN program must have the features of
Comparability - Precise replication of home country coverage
levels. Foreign assigned employees and dependents do not respond well
to coverage differences from home levels.
Case Management – For the US employer, foreign country
treatment is often less costly than US treatment, and plans are priced
accordingly. But that does not mean that case management and cost
containment is any less important.
Home Country Coverage – Just because they are assigned
to Bangalore for two years doesn’t mean they are not going to
need services at home. “Also-ran” home country coverage
and networks can be a nightmare for the plan administrator.
COBRA Coverage – One thing that is true of most plans
is that they just don’t want the COBRA ex-employee. The plan
selected must be a viable COBRA vehicle if required.
But equally important, both plans must be
effective in both premium and coverage
efficient and effective for the employee and the employer
integrated with home country coverages and global benefits strategy
emerging global strategies of many companies present unique challenges
for the employee benefits professional. Not the least of these challenges
is to develop a proactive, effective global program for meeting medical
and related needs in a dynamic organization … that is, before Martha
calls in the night.