Key metrics for the success of your group health plan

Group of people discussing their group health plan

Regardless of your industry, there are a number of components that make up the core of the most successful employment benefits packages, one of the most important (and in demand) being health insurance. The question here is how can you or your HR team judge the success of your plan while ensuring it is meeting the needs of your employees? Here, we discuss 7 key metrics that you can employ to help you gauge the success of your group health plan.

Metric 1 – Loss ratio

Calculated by taking the amount you pay (your premium) and dividing it by the amount the insurer pays out in claims, this ratio is essential in determining the health of your plan and is often used in calculating premium increases.

As an HR professional, knowing the ratio of your health plan and comparing it with industry standards can help provide you with a sound negotiation tool when it comes to negotiating premium increases or even coverage elements. In some cases, your current and historical loss ratio can even be used to provide a ballpark estimate on future premiums or premium increases.

Learn more about loss ratios in this article from Pacific Prime Hong Kong.  

Metric 2 – Average claims per member

Calculated by taking the number of claims submitted by the number of employees covered this will tell you, on average, how many claims are submitted each year by your employees. Comparing this to either an industry benchmark or historical average, this can gauge the overall utilization and satisfaction with your group health insurance plan.  

Tracking this metric also generates a wealth of useful group health plan data that can be used to help you not only better understand plan utilization. It also acts as a litmus test that can help to identify problems. For example, by tracking and analyzing the claims submitted by each person we are often able to help HR identify individuals who claim more than average along with individuals who are submitting costly claims.

From there, we help HR teams to work with these employees to help ensure they are receiving the support they need while ensuring claims do not massively impact the loss ratio.

Beyond that, this data can also help to uncover where your employees prefer to receive care. This information can be used to try to steer employees away from certain high-cost providers, or to identify whether the plan is actually meeting their health needs.

Metric 3 – Insurer/broker response time and claims processing time

Time, as you know, is money. Spending hours a day or month on chasing insurers or brokers for information or replying to employees who are having issues with plans can be not only frustrating but also take you away from working on other, possibly more important tasks. This is where this metric can help.

In truth, this metric can actually be made up of a number of similar metrics that when combined help you judge the overall level of service you are getting from an insurer. You can then compare this to your company and employee’s needs and judge whether the plan you have is actually working.

For example, many companies we work with will track things like number of claims vs broker/insurer response time, number of claims vs average time to settle a claim, number of claims vs employee complaints, and most importantly, when the insurer broker communicates.

Generally speaking, insurers with lower premiums will tend to have lower levels of service. Securing a plan like this will often save you money upfront, but if you have to spend half your day calling the insurer, not getting answers, waiting weeks for claims to be settled, waiting weeks for new members to be added, or old members to be removed, etc, you could end up actually paying more in the long run.

It is important to measure when the insurer or broker communicates important information to allow you to make timely decisions. For example, if they take a long time to provide claims details or renewal information this could leave you with little to no breathing room to find better coverage or negotiate for better premiums.

Metric 4 – The number of people covered by the group health plan

Commonly referred to by insurers as ‘participation rate’, this metric looks at the number of employees insured by a plan versus the number of employees eligible for the plan (achieved by dividing number of employees insured by number of eligible employees) and will often compare this percentage with a benchmark for similar businesses. In practice, this metric will actually vary for each company and is normally adapted to meet the type of insurance plan you have selected.

For example, in our experience, many companies are securing group health plans that cover inpatient care only. If an employee wants additional coverage for outpatient care the company will usually cover a percentage of the premium, say 50-80%.

Looking at the number of people who are securing additional coverage or have utilized extra coverage then comparing this to industry benchmarks can be a solid indicator as to the overall success of your plan. If you find that a higher percentage of employees are selecting to add additional coverage than the benchmark this will likely point to the fact that your plan is not being perceived by employees as useful. This, in turn, means it might be worth looking into upping benefits offered by your plan.  

Metric 5 – The ratio of dependents covered by your group health plan

This is certainly a metric that will not be used by all companies, but that said, it is an incredibly important metric for companies who extend their health insurance plan to employee’s dependents.

Calculated by taking the total number of participants and dividing it by the number of employees covered, this ratio can help determine whether you are covering more or less employee’s dependents.

It is important as, in our experience, it is often dependents who have the highest number of claims. This is especially true for children who are covered by the plan as children will statistically have to visit the doctor more often. In turn, this could have adverse effects on premiums your company pays.

If you find that you are ensuring more dependents per employee than is standard it might be worth looking into your plan and seeing whether this is having an impact on your premiums or claims.

Metric 6 – Employee demographics

This metric, calculated by looking at the number of employees and breaking them down into groups such as age, sex, location, etc., can be a major help in the search for group health plans and determining the overall satisfaction with it.

For example, knowing your the age groups of your employees can help you determine what types of cover will be most utilized and the potential medical issues your staff may seek care for. You can then search for plans that meet some of these needs or work to set expectations with existing plans.

Metric 7 – Questions asked  

Like some of the above metrics, this is really more of a series of different related measurements that can be tracked to help you with your plan. For example, by tracking the number of questions asked by new plan joiners, the number of questions asked by more senior staff, etc. you can gauge exactly how engaged people are with the plan.

If you see that new employees ask a fair number of questions regarding health benefits then it is probably a good indicator that there is confusion with the plan and better explanations/onboarding is needed.

It would also pay to track the types of questions asked and by whom. For example, if your team is getting a lot of questions about claims or benefit limits you this indicates that you might be spending an inordinate amount of time answering questions that could be avoided through better documentation. Beyond that, certain questions like “Can I keep my own doctor” could point to demand for a better provider network or potential areas where employees could be unhappy with the plan.

How can I set benchmarks and implement these group health plan metrics?

One of the best ways you or your HR team can implement and track the above metrics is to actually work with a broker like Pacific Prime. In truth, the majority of the above metrics are actually part of our corporate insurance service that we offer to all companies. Our team of corporate insurance experts strive to work with your business to ensure you and your employees have the most optimal coverage while reducing the amount of time you spend managing the plan and answering questions.

To learn more about our group health plan service, visit our new corporate site today.

New report focuses on the average cost of international health insurance

2017 Cost of International Health Insurance Report

Pacific Prime is excited to announce the release of our latest report: The 2017 Cost of International Health Insurance. Now in its third iteration, this free report takes an in depth look at the average cost of international health insurance in 100 countries around the globe. Download your copy from our website today.

As with previous versions, this year’s report is divided into sections that together provide an important overview of the current state of international health insurance and the factors contributing to the costs seen in 2017. This information, in turn, has proven to be a useful tool for both companies and individuals looking to get the most out of their health insurance.

Open version of the cost of international health insurance report

Section 1: Ranking the top 20 most expensive and bottom 5 least expensive locations

The first section of this report provides a brief overview of the average cost of health insurance and ranks the 20 most expensive locations along with the 5 least expensive locations. Before we look at this ranking, it is important to explain the data used to generate this report.

To generate these averages and provide readers with a sound benchmark we have combined data from 10 of the top international health insurers who each offer three levels of plan:

  • Plan 1: Inpatient cover only
  • Plan 2: Inpatient + outpatient cover
  • Plan 3: Inpatient + outpatient + maternity

For each plan we have pulled premiums for four major demographics:

  • Individuals: Male, aged 36
  • Couples: Male aged 36, Female aged 35
  • Families: Male aged 46, Female aged 35, and two children aged 10 and 5  
  • Retirees: Male, aged 60

By taking the premiums for each of the demographics above along with the three levels of plan and averaging them together for each country we have come up with our ranking for 2017.

This year, average premiums are spread out from between USD 19,724 and USD 7,027 with the US again taking top spot as the most expensive country for international health insurance: Angola, Ethiopia, and Mali are all tied as having the least expensive average premiums.

Click here to view the ranking on our website. We have also provided the full ranking based on the demographics above in the Appendix section of the PDF, which can be downloaded here.

Section 2: In-depth analysis on the cost of international health insurance

When analyzing this year’s premiums we uncovered six major findings, which are discussed in-depth in the Analysis section of the report:

  1. Premiums in the US increased by an average of nearly 14% from 2016 to 2017.
  2. Singapore has replaced China as having the third highest average premiums.
  3. South East Asia has seen a marked increase in ranking in 2017, with 5 countries ranked in the top 20.
  4. Average premiums in Dubai actually decreased in ranking slightly in 2017.
  5. A number of countries saw a decrease in average cost between 2016 and 2017.
  6. Many countries have the same average premium.

For each of these six major findings, we have included an analysis of why these are important and the factors behind them.

Aside from that, we have also included an update on the four primary global drivers behind the cost of health insurance. These four drivers being:

  • There is an increasing demand for international quality health care.
  • Almost every country in this report has seen an increase in the cost of health care.
  • There is a trend of increasing regulation in many countries and regions included in this report.
  • Many countries and insurers face continuing challenges related to fraud.

Two versions of the report

We have two versions of this report available. The first is the online version which presents a paired down look at the ranking and first part of the Analysis sections along with an interactive overview of the average costs in different regions.

The second is the full written report in PDF format which can be downloaded. This version includes our full analysis (the four drivers along with the six findings) along with a complete ranking of the average cost of international health insurance in each of the 100 countries for each of the demographics.

Where to get your copy of the 2017 Cost of International Health Insurance Report

As mentioned above, there are two versions of the report available. Both are free and can be found on our website, or by clicking the links below:

Download the PDF –

Read the online version –

Should you have any questions about the cost of health insurance, or your premiums, please do contact us. Our expert staff can help you find the best plan for your budget today.

What makes a good group health insurance company?

Tick boxes for a good group health insurance company

So you’ve set out to find a truly great group health insurance company to handle your organization’s insurance needs. Your team is focused on securing the absolute best possible group health insurance plan both for themselves, their colleagues and the company as a whole, but they begin to realize that finding the right group health insurance company can make all the difference in the world when it comes to finding great long term value from any potential insurance policy.  We all know generally that providing excellent customer service should be a priority for any company that we work with, but what specifically should you be looking for in an insurer? To aid anyone who is in a situation similar to the one above, Pacific Prime is proud to present this feature on what you should look out for when it comes to finding the best group health insurance company.

Group health insurance company experience

If there’s one characteristic that is common among the best group health insurance companies in the world, it’s experience. Putting in leg work and elbow grease over an entire career’s worth of time can really give an insurance agent the know how to get just about any task accomplished efficiently. The relationships that are forged with other insurance professionals can really help an agent’s clients out of some sticky situations. Now, take this individual experience and spread it across an entire company and it’s easy to see where the collective knowledge of a group health insurance company can be a force to be reckoned with. Here are some additional points with regards to experience:

Familiarity with industry

When you’re shopping for group health insurance, it will come as no surprise that you will be better off choosing an insurer that has knowledge and experience within your organization’s particular sector. This is because the group health insurance company will then be familiar with the specific problems that organizations like yours faces on a regular basis. As well, an insurer should be versed in handling an organization of the same size as yours. If they mostly have experience with individual medical insurance policies, they may not be able to handle the workload that a large group policy may require.

For instance, an insurer that is familiar with insuring schools will know all the in and outs of insuring teachers, as well as the importance of addressing your policy requirements at specific times of the year. After all, schools run on a schedule that other businesses don’t, so getting insurance needs done and dusted before the summer break is important. There are many small aspects like this that need to be considered for every industry, and an insurer unfamiliar with yours is much more likely to overlook something that a more experienced insurer would not.

Claims data analytics

Once you’ve actually secured your policy from your group health insurance company, that isn’t the end of the transaction. A group health policy requires regular communication with your insurer combined with ongoing maintenance. This is because the policy will inevitably be used, and claims will be made on it by your members. The thing about these claims is that they can be studied to give insight into the future of your policy. By establishing claims trends, an experienced insurer can then determine if your benefits are serving you as well as they should, and clue you into any potential premium rises way before they actually happen. As well, plan administrators can be notified by the insurer if your employees aren’t using their insurance enough, or if the plan is used far more than originally thought.


Once enough data has been collected about your organization, how will you know how you stack up versus similar or competing organizations? A competent group health insurance company or broker will be able to provide exactly this type of information. Pacific Prime, for example, has established such a large portfolio of clients over 17+ years of operation that we can confidently explain to our potential members exactly what kinds of benefits they should have to keep up with competitors or how their plan is performing vis-à-vis others in their sector.

Group health insurance company approach

Despite the above section, even a newer group health insurance company can be effective. Sometimes it’s all about their approach to the market and how they regard their clients that makes all the difference. With this in mind, you should be looking for an insurer with some of the following qualities:


When renewal time comes up for your group health insurance policy, negotiations can be tough. This is one of the main points where utilizing an insurance broker will be of special value to you, as they can help you negotiate terms of your next policy with your group health insurance company. Negotiating on your own, you will not have the unbiased advice that comes with a broker, and it will be on your staff to analyze your claims data to try to recognize if you’re getting a good value with your current plan. Pacific Prime’s mantra during the negotiating process is to always look out for our members’ best interests, and not those of the insurance provider.

Manage premium cost and stability

Going right along with negotiations are managing premium costs. At negotiation time, most of the time a group health insurance company is going to want to raise premiums, as medical costs tend to raise year-over-year and other factors are taken into account. What your organization will want is proof that a premium rise is justified, and that it’s not time to switch to another insurer.

Fortunately for Pacific Prime members, they will be able to address potential premium increases armed with knowledge. They will either know that the increase is appropriate, or they will be able to dispute the rise, backed up with facts and statistics that support their argument. Thereby keeping premiums low and, hopefully, avoiding switching insurers on too frequent a basis.

Customized service teams

Many times people will find that they do not get the service they need from a group health insurance company for one of two reasons. The first is that they are assigned a single person to assist them with their insurance plan. While this person may have all the experience and knowledge in the world, sometimes having only a single point of contact to work with will be overwhelming for them, and your plan performance may suffer as a result.

On the other hand, you could be given access to the entirety of the staff that an insurance company has, yet be left without a particular person to hold accountable. This means that, when you’re in need of insurance advice, you may have to explain who you are and what your problem is to somebody that is not familiar with your organization at all.

To avoid both of these issues, it’s best to find a company to work with that will provide you with a bespoke team that will be very familiar with your organization’s specifics. By having a number of people assigned to you, but also limiting the people responsible for your plan’s performance, a balance between knowledge and responsibility can be maintained.

With all of the above points in mind, we are confident that you will find that Pacific Prime are the insurance experts that you should be working with. Not only do we have all of the points above in spades, as a broker we are also in a unique position to offer you plans from the industry’s top insurers. This will save you much time and energy when searching for a new group health insurance plan, because you will not have to sift through all of the insurers and plans on the market to determine which fits you the best. Our agents will find and present the best available options to you, combined with the advice that you can only get from an experienced, multinational insurance broker.

Our agents are available today to help you find the best possible group health insurance company. Contact us today for a plan comparison and free quote!

Pacific Prime joins Worldwide Broker Network

cyber attacks

HONG KONG – Leading insurance intermediary Pacific Prime has just been announced as the newest Asia Pacific Region member of the Worldwide Broker Network ™ (WBN), a global network of commercial insurance brokers and employee benefits consultants.

Connecting with more than 100 firms across six continents, Pacific Prime is now in a better position than ever to support its clients with the same high standard of customer service it delivers now. Becoming a Worldwide Broker Network member gives the Hong Kong-based intermediary access to a much wider network of leading brokers than before, which will help to support Pacific Prime in providing client-centric solutions.

“Ultimately, it’s about expanding our reach and services for the good of our clients.” says Pacific Prime CEO, Neil Raymond. From its beginnings in Hong Kong, Raymond has grown the company to include 400 staff across seven offices.  “The privilege of joining such a comprehensive organization of brokers is one that supports our client-centric focus and we look forward to offering the WBN our 17 years’ experience in the Asia Pacific region.”

WBN Chief Executive, Francie Starnes, has welcomed Pacific Prime’s membership. “Pacific Prime is bolstering the representation of WBN in the Asia region, which is a critical and growing market for our network. We welcome this expansion of client based services to our members, and look forward to adding Pacific Prime’s expertise to the expansive network.”

The WBN boasts local knowledge and experience through its global network, made up exclusively of top quartile firms that are independently owned and managed. It encourages cross-border collaboration and operates under a member-to-member accountability model that promotes quality service whilst still maintaining the independence of its member firms.

Global Director of Corporate Accounts at Pacific Prime, Pierre de Mirman, will be the primary contact for all Employee Benefits and Property & Casualty opportunities. Working with the WBN to meet membership standards, de Mirman says his team are keen to utilize the benefits of the Network to widen Pacific Prime’s insurance solution capabilities for its corporate clients.

About Pacific Prime

Pacific Prime was founded in 1999 by Neil Raymond as an expert P&C and Employee Benefits consultancy. Headquartered in Hong Kong, the company operates from a number of licenses in many countries around Asia and the Middle East, serving more than 500,000 clients with its over 60 insurer relationships.


About the Worldwide Broker Network ™

Founded in 1989, Worldwide Broker Network has grown from nine member firms in Western Europe to more than 100 firms spanning the globe and serving clients through 500+ offices in six continents. Today, as an important part of the insurance industry’s distribution network, WBN generates over $5 billion in P&C and Employee Benefits revenue annually.



Pacific Prime Wins Bupa 2016 Innovative Excellence Award

The Pacific Prime China team at Bupa's award showcase

(Hong Kong, March 6, 2017) Pacific Prime is proud to announce that leading insurance provider Bupa Global has awarded Pacific Prime with the Bupa 2016 Innovative Excellence award at the 2017 Bupa Global Greater China Distributor and Partner Conference.

The Bupa 2016 Innovative Excellence award was presented to Pacific Prime in recognition of their latest achievement as the brokerage that displayed the most innovative sales and marketing strategy in the Asia region in 2016.

Neil Raymond, Managing Director at Pacific Prime, commented: “We are honored to receive such prestigious industry recognition, as meeting the needs of our clients and the industry are integral to everything that we do. By leveraging our 17 years’ experience in the industry, the innovative solutions that we provide to individual and corporate clients are at the forefront of the insurance industry.” 

The Bupa award for innovative excelence awarded to Pacific PrimeThis prestigious award took into account Pacific Prime’s bespoke approach to delivering an outstanding customer service experience, which is backed by their ‘Broker Framework Model’, a holistic value system that embodies all aspects of the firm’s consulting, policy broking, and plan administration strategy. Pacific Prime’s innovative approach to individual and corporate sales is also backed by dedicated sales and renewals teams, and further streamlined by their state-of-the art CRM system.

Bupa Global further recognized Pacific Prime’s innovative excellence in marketing, particularly their dedication to releasing insightful industry reports on International Private Medical Insurance, including the Cost of International Health Insurance Report 2016, and the International Private Medical Insurance Inflation 2017 report. Besides further establishing Pacific Prime’s reputation as a key knowledge leader in the insurance industry, the reports help customers to make more informed purchasing decisions and act as a valuable benchmark that allows insurers to see what other providers in the industry are doing.

Sheldon Kenton, Managing Director at Bupa Global, commented: “Pacific Prime has consistently pushed the envelope in terms of maximizing their digital customer relevance and natural search authority via in depth reports on the industry, a very clear and consistent target customer focus and smart content marketing. I congratulate them on this well deserved award.”

Pacific Prime has worked in partnership with Bupa Global for over 13 years, and these awards are a continued reflection on the longstanding, successful relationship between two major players in the insurance industry. On this, Raymond expanded saying, “Pacific Prime continues to push for innovation and taking a proactive approach to helping our clients, and have been recognized by Bupa and most of the insurers on the market for our continued high level of consulting and servicing provided to individuals and groups throughout the world.” 

About Pacific Prime

Headquartered in Hong Kong, Pacific Prime is an award-winning insurance intermediary that leverages its longstanding partnerships with over 60 leading insurance providers to provide the best value insurance services and products to individual and group clients. For more information, visit:

Pacific Prime looks at international medical insurance inflation

Cover of the 2017 medical insurance inflation report

We are proud to announce our latest report focusing on medical insurance inflation has been released. Titled, International Private Medical Insurance Inflation -2017 this report (available for free here), like previous years takes a look at private insurance premiums around the world and what’s driving them up. Again, we look at the insurance products of eight global insurers that offer the same products in 10 selected regions around the world.

In this blog post, we’re going to briefly highlight some key points from the report. The report itself will be of high interest to individual and corporate clients who are watching their budgets, while insurers and brokers (corporate brokers and individual brokers) alike may use the information to help inform their clients about the cost of insurance around the world.

Key results

The new report shows that the average percentage increase of IPMI around the world was 9.2%. While being exactly the same as 2015’s inflation rate, the IPMI report also shows which insurers came in this year with the lower average premium increase worldwide, and the average for the last five years:

Top 3 Global Insurers with Lowest Average Premium Increase (2017):

Top 3 Global Insurers with Lowest Average Premium Increase (2009-2016):

  • Aetna International – (InterGlobal)
  • Allianz Worldwide Care
  • William Russell

It should be noted that these are not the insurers with the lowest premium prices, but those whose rate of premium price inflation was the lowest in the areas the report focuses on.

Drivers of inflation

Again, the IPMI report focuses on some key factors that positively or negatively impacted the rate of premium inflation for this past year. Across the regions (Asia, the Middle East, and the Rest of the World), Pacific Prime found that the drivers present in previous reports were still relevant for this year:

  • New medical technology
  • An imbalance of healthcare resources
  • Increased compensation for healthcare professionals
  • Healthcare overutilization

In addition to this, three new drivers have been proposed as having the potential to significantly impact premium increases in the future:

  • Unstable economies (New for 2017)
  • Changing population dynamics (New for 2017)
  • The increasing availability of technology (New for 2017)

These newer drivers take into account the tougher economic times the world has been facing and explain how the population of insurance consumers has been impacted in the various regions. Places like Hong Kong and Singapore have noticed a clearer division in the age and experience of expats arriving to their shores, while countries like Indonesia and the UAE have noticed a significant shrinking of expat numbers.

The impact of technology in monitoring, analysis and creating efficiencies in the insurance sector are another new driver. While it was expected to have a significant impact on the price of IPMI insurance, the report has found that insurers are still some way from fully realizing the benefits of technology. Wearable tech and big data use is still in its infancy, yet many insurance companies are making headway with online portals and smartphone apps.

Major change from previous reports

Another feature of this year’s IPMI report is that Dubai has been significantly changed by its 2015 introduction of compulsory health insurance laws. Over the past year, all residents (local citizens and expatriates alike) have been required to obtain a minimum level of health insurance coverage. Those not complying are soon due to face fines for not meeting the new laws.

In the report, the usual Dubai section has been replaced with a discussion on how these changes have impacted both insurers and their products in the UAE. Some insurers have chosen not to replace the IPMI offerings that were found to be non-compliant with the new laws, while those that did replace their plans had premiums driven by the law change as opposed to the inflation drivers affecting the rest of the world.

The International Private Medical Insurance Inflation Report 2017

The  International Private Medical Insurance Inflation 2017 report is available as a free download, directly from the Pacific Prime website. An online version of the report, complete with interactive graphs and sections, is also available here. View the report today. 

Pacific Prime, an expert in insurance and healthcare, secures contract with one of the largest designer eyewear e-retailers: The SmartBuyGlasses Optical Group

SmartBuyGlasses and Pacific Prime Logo

The SmartBuyGlasses Optical Group turns to Pacific Prime to help manage their global health insurance needs.

Eyewear and healthcare go hand-in-hand, and that is why The SmartBuyGlasses Optical Group has established a collaborative partnership with Pacific Prime. Operating in over 30 countries, The SmartBuyGlasses group has employees from over 30 different countries and 15 different languages meaning an expert insurance provider is a must.

This newly established partnership goes beyond an insurance provider for SmartBuyGlasses’s international employees. With the E-retailer recently celebrating 10 years of expertise, it enables SmartBuyGlasses to share with Pacific Prime deep insights into the eye health industry, along with the latest products and services available, which in turn can be passed onto Pacific Prime clients when they encounter specific eye health issues.

This is the start of a flourishing relationship between the two health-orientated companies with both organizations having the same company core values of providing their customers with the best health expertise, product and service for their needs. Doron Kalinko, CEO and Co-founder of SmartBuyGlasses Optical Group remarks ‘I am very excited about the new partnership with Pacific Prime, we have been looking for an expert insurance provider and feel the partnership has huge benefits for both our employees and customers. I am looking forward to developing this collaboration over the next few years’

To find out more visit SmartBuyGlasses or Pacific Prime.


For further press information, case studies, or interviews, please contact Julia Ritchie Global PR manager for SmartBuyGlasses Optical Group at [email protected]

About The SmartBuyGlasses Optical Group

The SmartBuyGlasses Optical Group, operated by Motion Global Ltd is the world’s leading online designer eyewear destination with operations across Asia Pacific, Europe and the Americas. Since 2006, SmartBuyGlasses has empowered customers in over 30 countries to shop their own style and find what they love by offering over 180 brands and 80,000 different products.

About Pacific Prime

Pacific Prime, in operation for 16+ years, offers a wide range of international health insurance plans and cover for individuals, families, and organizations around the world.

With a multicultural team of skilled and qualified professionals, Pacific Prime makes it simple for you to find the best insurance. All insurance plans are backed up with expert advice which encompasses policy selection, claims handling, administration, and policy renewal all offered free of charge.

PP’s Neil Raymond featured in new IPMI interview

Globe to showcase IPMI

Over the past couple of years, Pacific Prime has been striving to launch an increasing number of beneficial reports on the International Private Medical Insurance (IPMI) industry. Our latest report published in the summer of 2016, the 2016 Cost of Health Insurance Report, has enabled clients and industry professionals alike to gain greater understanding of the cost of health insurance around the world and the major contributors driving these prices.

One of the biggest findings from this report is the fact that the US is once again the highest cost location for international health insurance. While there are many factors that contribute to the high cost of medical insurance in the US, one thing we highlight in the report is the fact that the Affordable Care Act has had a huge influence on what you can expect to pay for insurance.

ACA and international coverage

Since its implementation in 2014 many international insurers have been working on getting plans launched that not only meet the strict ACA mandates but also provide both inbound and outbound American tax payers worldwide health coverage.

In early November, a new international health plan that provides international coverage while also being ACA compliant was launched from Cigna. We believe that this is the start of a new trend and as such have created a new ACA information portal. This portal is designed to provide both inbound and outbound taxpayers everything they need to know about the mandated health insurance coverage.

What are Pacific Prime’s thoughts on the ACA and the cost of health insurance?

In the insurance industry, the release of the cost of health insurance report and the introduction of ACA compliant plans for international expats and residents has created a number of talking points, especially around how these will impact one another.

To that end, Pacific Prime’s CEO and Founder Neil Raymond sat down with Global Health Insider for an exclusive interview on the topic. The interview, available to read now on their website, covers a wide variety of topics including:

  • The recent launching of an ACA-compliant international health insurance plan.
  • Key findings from our latest cost of health insurance report.
  • Dubai’s rise to prominence in the international health industry.
  • Important IPMI trends
  • And more.

Check out the interview now for an exclusive in-depth look in at international health insurance.  

What expats need to know about the Affordable Care Act

'Murica flag to represent Affordable Care Act insurance

In our latest report on the cost of health insurance, we found that the US is the single most expensive location on earth for health insurance. One of the main reasons why the US is so costly is the fact that healthcare is so expensive, meaning that people essentially need health insurance if they plan on visiting a doctor in the US. It is primarly because of this fact that the US government took steps to drastically overhaul the healthcare system in the US. The major outcome of this overhaul is the Affordable Care Act (ACA). If you are an expat considering moving to the US or will be moving there shortly, there are a number of things you need to be aware of regarding the ACA.

What exactly is the ACA?

The Affordable Care Act, officially called the Patient Protection and Affordable Care Act (PPACA), commonly referred to as ‘Obamacare‘, was enacted in 2010 with the goal of lowering the uninsured rate, increasing insurance quality and affordability, and generally decreasing the burden of healthcare costs for people in the USA.

In order to achieve this, the US government set out a number of mandates, two of the most important being aimed at insurers and individuals. For insurers, the ACA states that they must accept all applicants, cover a set list of conditions (including many pre-existing conditions), and charge the same premiums for all applicants.

For individuals, the ACA mandates that you are required to secure compliant insurance plans should you not have one provided by either your employer or a public insurance plan. Interestingly, the fact that you ACA compliant plan is proven via one’s tax returns, and should you not have the required level of coverage, you could be slapped with hefty fines.   

Who needs to secure ACA plans?

When it comes to the ACA there are two major groups who are required to secure ACA compliant plans: Individuals and companies. Where there can be some confusion around the ACA is inbound and outbound expats, and whether you are expected to secure a compliant plan or not.

The ACA mandate for companies

According to the IRS, if your company employs more than 50 people, you are required to provide ACA compliant health insurance to at least 95% of full-time employees and their dependants under the age of 26.

Should you have fewer than 50 employees, you are not actually required to provide health insurance coverage to them. Rather, it is encouraged that you do. In order to help cover the costs of health insurance for these smaller groups, the IRS does offer tax rebates and options for offsetting the cost of providing health insurance.

For more information on the ACA for employers, check out the IRS website here.

The ACA mandate for individuals and their families

Generally speaking, all individuals who pay tax in the US are required to also secure an ACA compliant plan either through their employer or through insurance marketplaces should their employer not provide health insurance coverage. This mandate also extends to spouses and dependents under the age of 26.

In other words, if you are required to submit a tax return with the IRS, then you are more than likely required to also have secured ACA compliant health insurance, or you will have to pay a fine. Of course, there are a number of exemptions, which are explained in great detail in this PDF from the Congressional Research Service. You can also visit the IRS’s ACA for individuals website, which has an interview that helps determine whether you are exempt from this mandate or not.

The ACA individual mandate and expats

Being an expat who is either going to the US or will be leaving the US for work overseas, it can be confusing as to whether or not you are required to secure an ACA compliant plan, especially due to the fact that the US has historically strict tax laws.

As an outbound expat (someone who is a US citizen, but will be leaving for work overseas), you are still legally required to have an ACA compliant plan if you live abroad for 330 days a year or less. Should you go for, say, six months and then return, you will still need a compliant plan. For those who do spend the majority of the year outside of the US (more than 330 days), you are deemed to have an ACA compliant plan, and can tick the relevant box when you file your tax return.

As an inbound expat, if you are paying taxes in the US and spend more than 35 days a year in the US, you will be required to secure a compliant plan. The key thing to stress here is that this mandate applies to US citizens, legal US residents, resident aliens and non-resident aliens required to file tax forms. Some students and diplomats are exempt from the mandate, but the vast majority of inbound expats will need a compliant insurance plan.

What happens if I don’t secure a compliant plan?

The US government officially follows what they refer to as a “play or pay” policy when it comes to the ACA and the securing of plans. If you do not secure a plan that meets the requirements set out by the government, you will be fined. Of course, in the US nothing is ever fully ‘mandatory’. You will not be arrested or deported should you not have a compliant plan, you will just have to pay the fine.

For businesses these fines are referred to by the IRS as “Employer Shared Responsibility Provisions,” and the fine will vary depending on the situation. For example, if you have over 50 full-time employees and do not offer health insurance to at least 95% of your employees you will be fined at least USD 2,000 per employee with the first 30 employees not being counted. More information on the fines can be found here.

Individuals who do not report adequate coverage will be similarly fined, or as the IRS puts it, you will be required to “Make a Shared Responsibility Payment”. The exact amount will vary based on a number of conditions, including your annual salary, dependants, etc. You can learn more about this payment here.

Can I secure a plan before I leave for the US?

As an expat heading to or leaving the US, there is a good chance you will be returning to your home country for a vacation at least once a year. Historically, if you wanted to have coverage in your home country and in the US, you would be required to have both an ACA compliant plan and an international health insurance plan primarily because many insurers who offer global health insurance plans do not meet requirements set by the ACA.

As of November 1, 2016 however, Pacific Prime is pleased to announce that we will have an international health insurance solution that offers not only worldwide coverage, but also will be ACA compliant. This plan, offered by Cigna Global, can be a great option for any expat moving to the US, as well as expats leaving the US for a position abroad.

Visit our Cigna International Health Insurance page on this exciting new plan to learn more today.

A story about pneumonia

Pneumonia virus

Did you know that according to the WHO “Pneumonia accounts for 15% of all deaths of children under 5 years old, killing 920,136 children in 2015.”? But it’s not just children who are affected, as you have probably read in the past few weeks a certain American presidential nominee was said to be suffering from a form of pneumonia, once again bringing this serious condition to prominence. While it has largely been shaken off by the aforementioned candidate, pneumonia is a condition that should be taken seriously, as one of our colleagues found out a few years ago. In this article we take a look at pneumonia, share our colleague’s experience with the infection, and the condition’s link with health insurance.


What exactly is pneumonia?

Pneumonia is a term used to describe an acute infection of the lungs, most commonly caused by either a virus, bacteria, fungi, or aspiration of material into the lungs. This infection results in the alveoli (sacks in our lungs that allow the transfer of oxygen and carbon dioxide into and out of the lungs) filling with fluid, which in turn makes it hard for us to breathe.

Because there are a number of different causes of pneumonia, doctors will typically try to differentiate the infection into a number of different types, which will then dictate treatment. The most common types of pneumonia include:

  • Community-acquired pneumonia (CAP) – This term is used to describe pneumonia caught in public spaces i.e., not the hospital or care center. An infection developed during a cold or flu is also usually labeled as community-acquired pneumonia.  
  • Hospital-acquired pneumonia – Pneumonia contracted while you are in the hospital. The vast majority of cases of hospital-acquired pneumonia develop while you are in the hospital for another health issue e.g., surgery or long-term care.
  • Viral pneumonia – Pneumonia caused by a viral infection that can be contracted either at the hospital or in the community. One of the most common causes of viral pneumonia is the respiratory syncytial virus. Like other viral infections, antibiotics won’t usually help patients recover.
  • Bacterial pneumonia – Like viral pneumonia, this can be contracted both in the community and in healthcare centers, but this type of pneumonia is caused by bacteria. According to Everyday Health, “60 percent of all CAP cases are caused by bacteria called Streptococcus pneumonia, also known as pneumococcal pneumonia.”  
  • Fungal pneumonia – A type of pneumonia caused by a fungal infection or the inhalation of fungi, and is most commonly seen in patients with other underlying health issues such as those with an immunocompromised/immunosuppressed system.  
  • Aspirated pneumonia – Pneumonia that is caused by inhaling a foreign object into the lungs such as food, liquid, or even gastric material such as stomach acid. This is commonly treated like viral pneumonia, with antibiotics.    
  • Walking pneumonia – Also commonly referred to as atypical pneumonia, this is essentially any form of pneumonia that doctors deem not serious enough for hospitalization. In other words, it is a milder form of pneumonia.  


What are the common symptoms?

There are actually two common sets of symptoms with most types of pneumonia: bacterial pneumonia and non-bacterial pneumonia. Should you develop the symptoms below, it is advisable to consult with a doctor or go to the hospital if they are serious enough. Doctors will usually do a blood test and an x-ray to see if there is fluid in your lungs. Tests will then be run to confirm what type of pneumonia you have. From there you may be admitted to the hospital or given antibiotics.  


Symptoms of bacterial pneumonia

While these symptoms may be different for each patient, most people will notice:

  • A productive cough with phlegm that is green or rusty in color. There may also be blood in the phlegm.
  • Fever.
  • Strong chills that lead to teeth chattering.
  • Shortness of breath with fast shallow breaths.
  • Pain in their chest, especially whey they breathe in.
  • Feeling tired and drained of energy.
  • Nausea.
  • Night sweats or excessive sweating at night.  

For many people who contract bacterial pneumonia, the symptoms will usually come on seemingly all at once and will commonly start during or just after a cold, flu, or upper respiratory tract infection.


Symptoms of nonbacterial pneumonia

For most cases, the symptoms of nonbacterial pneumonia will actually feel quite similar to a cold or flu and will commonly include:

  • Light fever.
  • Dry cough with little to no phlegm.
  • Shortness of breath.
  • Headache.
  • Muscle pain or weakness.

The main difference here is that, while cold and flu symptoms will tend to lessen after a couple of days, these symptoms stay or even get worse as time goes on. For example, you may find it harder and harder to breathe, your cough gets worse, and fever increases. Other times, you may not even know you’ve had pneumonia, this is what doctors refer to as walking pneumonia.


Is pneumonia contagious?

No, and Yes. The vast majority of common pneumonia are not actually contagious. If someone you know is diagnosed with it, it does not mean that you too will catch it. Instead, it is the viruses or bacteria that cause pneumonia that are contagious. If you are exposed to the virus or bacteria, then you could get sick and could see pneumonia develop if your body can’t fight the illness.


Our colleague’s experience with pneumonia

When discussing this article and the situation that sparked the idea to cover it, we found that one of our colleagues on the marketing team actually had an interesting bout of pneumonia a few years ago. Here is his story:

“In April 2012, a few months after I had moved to Bangkok from Hong Kong for a new job. I had settled into Bangkok nicely and was enjoying the city, but had to return to Hong Kong for a visa run. About a week before my trip back to Hong Kong I caught a pretty nasty cold and spent a few days in bed recovering. It was one day before my flight and I felt better, so I decided not to postpone my trip. This, I believe, turned out to be a major mistake!

On my flight to Hong Kong, I was sat beside a guy who sounded like he had a miserable cold. A nasty, near constant cough, the continuous blowing of his nose, etc. More than once he sneezed without covering his mouth and I am fairly certain I was exposed to his germs. That night I felt ok and went out to catch up with old friends from Hong Kong. By the end of the night, however, I was feeling like another cold was coming on and decided to get some extra sleep.

Throughout the weekend, the symptoms digressed and I really felt like the cold was in my chest. By Sunday night I remember feeling extremely tired, it was hard to breathe, I felt nauseous, and I certainly had a fever. I took some Panadol cold medication to try and break the fever and went to bed at 6:00 pm, thinking a good night’s sleep would do the trick, as I had to fly back to Bangkok the next day.  

I vividly remember waking up at around midnight with the sheets soaking wet from head to toe. I thought to myself that this was great, the fever had broken and I was just ‘sweating it out’ as I changed the sheets and went back to sleep. The next morning, Monday, I woke up feeling worse but decided that I felt well enough to fly back to Bangkok where I could take a few days off at home and rest.  

That flight back to Bangkok was one of the worst flights I have ever taken. My breathing had somehow gotten worse with a dull pain whenever I took a breath and my fever was back. By the time I got back to my condo in Bangkok I was exhausted and was now coughing up phlegm, but I decided to just go to bed instead of going to the hospital.

The next morning, I woke up and coughed up some phlegm. As I spit it out into the sink, I noticed that there was a blood in the phlegm. My exact thought being “Hmm, that shouldn’t be there. I think I should go to the hospital.” My next thought was “Which hospital do I go to? I can’t speak Thai.”  

Luckily, my uncle also lived in Bangkok at the time, so I called him and he instructed me to go to Samitivej Hospital, one of the international hospitals in the city. I checked into the hospital, filled out the paperwork and sat down where they told me to. A few minutes later a nurse came along and asked me to explain my symptoms, which I did:

  • Fever
  • Night sweats
  • Phlegm with blood
  • Chest pain when I breathe in
  • Extremely weak and tired.

She got a very, very worried look on her face and immediately called a wheelchair over. I was taken right into the doctor’s office at the pulmonary ward and given a chest x-ray along with a blood test. Reviewing the x-ray, the doctor told me that I had a fever of just under 38 degrees along with a worrying amount of fluid in my lower right lung (in other words pneumonia). I was subsequently admitted to hospital for three nights and then told to take three weeks off of work to recover. I was also diagnosed with asthma, which I still have to take an inhaler daily to keep under control.

Now, you are probably asking “Why didn’t I go see the doctor in Hong Kong? Why did I wait so long to see a doctor in Bangkok?” Well, the answer to that is that I did not actually have health insurance. Through a slip-up at my new company, my company-sponsored health insurance application was not actually submitted when it should have been, which meant I had not received coverage before I got sick.

At the time, I was not making a lot of money and knew I couldn’t afford a hospital visit, even in Thailand. Because of this, I ended up having to borrow money from my uncle to cover the costs of care, which came to THB 55,000 (almost double my monthly salary at the time). To make matters worse, when my insurance application was accepted (after I recovered) the insurer denied coverage of asthma due to the fact that it was a pre-existing condition. All of this could have been avoided if I had health insurance.

Yes, it was from this experience I learnt a valuable lesson the hard way: If you are going to move countries, ensure that you have health insurance in place before you move. The cost of securing an international health insurance plan may seem like a steep investment, but it pales in comparison with potential medical bills. I wish I had known of Pacific Prime before I left Hong Kong!”

If you would like to learn more about your health insurance options before you move countries or even jobs, contact Pacific Prime today.