Choosing An International Health Plan- Checklist For Buying Expat Insurance Coverage

Buying expat insurance coverage is a vital part of moving abroad. But it doesn’t have to be complicated or expensive. There are several factors you need to understand. Use this international health plan checklist to find the clauses in your policy hiding critical information that can be costly to ignore. minutes

  Mins Reading Time

Published On: October 12, 2022

Latest Update: April 10, 2024

About the author

Hi, I'm Marco Sison. I worked in finance for Fortune 50 companies before retiring early at 41 years old. I have been an expat for over 10 years, living in over 50 countries to show you the best ways to save, invest, and live in amazing countries outside the USA. I am a trusted resource on personal finance and overseas retirement for US News & World Reports, HuffPost, MSN Money, USA Today, ABC Network, Yahoo Finance, Association of MBAs, the iTunes documentary Seeking FIRE, and the Amazon Best-Seller- Abroad: Expats That Thrive.

QUICK SUMMARY- Worldwide Health Plans

  • Details matter. Understanding the fine print in your medical policy is important
  • Don't focus on just the annual premiums. Look at the total cost of insurance with coinsurance, co-pays, and deductibles. 
  • Evacuation and repatriation are the critical, but overlooked benefits for expat insurance.
  • If you have any chronic conditions, double your policy for potential sub-limits.
  • Health plans typically have annual, lifetime, and per benefit limits.
  • Once your plan's limit is reached, you are responsible for any medical expenses for the rest of the contract.

Healthcare is complicated (and ridiculously expensive!), especially if you live outside the United States. But it's even more complex if you plan to live in another country and need worldwide coverage for you and your family.

The unique needs of expat life require a high-quality international health insurance plan to provide emergency treatment and protect you when moving abroad.

But buying an international health plan is not as simple as it sounds. Before putting your credit card info to purchase, many factors must be considered, including understanding your deductibles, waiting periods, maximum limits, and finding potential discounts.

The key is knowing which clauses are important and understanding where your policy hides critical information that can be costly to ignore.

This checklist will show you what clauses to watch out for and help ensure you get the right coverage while getting the most bang for your buck.

I'll cover topics you should look for in your policy document before purchasing a global health insurance plan. Including:

  • Understanding what waiting periods are and how you may not be reimbursed if you see a doctor, even if you are sick and have insurance
  • How to find and negotiate discounts with your primary insurance company to slash your annual costs
  • How to get a refund if you are unhappy with your plan's health care benefits
  • What coverage option is needed to ensure you get proper medical treatment if you fall sick in the jungles of some remote location in a foreign country

This checklist covers everything you need to know before buying international health insurance. Don't worry - I've included links to resources where you can learn even more.

This post may contain affiliate links. I may get a commission if you purchase something using my link. Please note, there is NO ADDITIONAL COST to you. For more information, please see my disclosure.

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What is an international health plan?

Global health insurance acts as a safety net for you and your family when you are living abroad and need medical assistance. International health plans can cover everything from routine check-ups to severe injuries like broken bones or even pay for cancer treatment.

Most international medical insurance plans provide a basic level of coverage but then allow you to custom-build a plan with optional add-on features. Add-on features can include prescription medications, vision, and dental care coverage.

Why is it important for expats to have international health insurance?

Uninsured expats involved in a catastrophic major medical emergency like a heart attack or motorbike accident can get financially devastated. A worldwide health plan is your financial shield and proverbial lifeline if you or someone in your family falls sick or suffers a severe accident.

Here are examples of unfortunate expats that needed their global insurance to pay hundreds of thousands of dollars for medical evacuation after an injury while abroad:

  • Brain hemorrhage on a cruise in China- Insurance paid $232,000 USD
  • Slipped in the bathroom and fractured spine in Thailand- Insurance paid $159,000 USD

Living in another country is an exciting experience, but can pose many potential risks. Your health abroad should not be one of those risks. An international health plan is designed to provide the long-term worldwide medical coverage you need for illness or injury while living abroad. 

If you get seriously injured, international plans include emergency evacuation and repatriation coverage to get you home or to another country with better medical facilities.

Additionally, many countries require adequate health coverage before granting you a visa or, in some cases, before even allowing you to enter the country. Buying an international health insurance plan fulfills these requirements.

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Click here to find the FREE estimates from top global insurers to find the best plan right for you.

What are the benefits of an international health plan?

  • Access to health care: You will enjoy the advantage of being covered in the country where you reside and any country you travel to, including your home country.
  • Flexibility to choose medical care providers: You can choose a private hospital over a public facility and receive faster, more comprehensive, and better healthcare.
  • Wide range of coverage- optional add-ons include maternity benefits, dental, vision, prescription benefits, extreme sports cover, and more. Optional benefits allow you to build health coverage that matches your lifestyle with a cost of healthcare that fits your budget.
  • Emergency medical evacuation or repatriation flights- your plan provides with air transportation if you are injured in a remote location or require treatment in a foreign country with inadequate health care providers

What are the different types of international private insurance plans?

Global Private Health Insurance - expensive option with the best range of cover

Cigna Global




Cigna is one of the best expat medical insurance companies in the world
  • Most popular expat medical insurance company
  • Customizable plans allowing you to pay for only the coverage you need, while offering flexible monthly rates 
  • Extensive global medical network of over 1.65 million hospitals and healthcare professionals in over 200 countries

Average Cost 


Maximum Limits

$1,000,000 - Unlimited

Travel or International Medical

International Only

Ideal For- Older expats with health concerns or chronic conditions





  • Offers global citizens several types of plans, from trip insurance to premium level comprehensive international medical coverage.
  • Has a global private network of 1.7 million healthcare practitioners, clinics, and hospitals in 190 countries.
  • The largest expat insurance company in the world. Part of US insurance company Blue Cross Blue Shield that protects 1 in 3 US citizens.

Average Cost 


Maximum Limits


Travel or International Medical


Ideal For- American expatriates who need comprehensive benefits and frequently return to the US

Travel Medical Insurance - affordable option with the less coverage

Safety Wing




  • Travel medical and trip insurance that you can purchase without long-term commitments or annual contracts.
  • You can sign up and start your coverage abroad, even after leaving your home country.
  • Very restrictive limitations and exclusions for pre-existing conditions and chronic illness.

Average Cost 


Maximum Limits


Travel or International Medical


Ideal For- Younger digital nomads with no pre-existing conditions needing travel health insurance.

IMG- International Medical Group




IMG is consider the best international health insurance company's customer service
  • 25 international health insurance plans from travel medical (Patriot Plus) to international medical (IMG Global Medical)
  • Highest ranked customer satisfaction of any expat medical insurance company on the list
  • Insuring expats in 190+ countries with 800,000+ doctors and healthcare facilities worldwide

Average Cost 


Maximum Limits

$1,000,000 – $8,000,000

Travel or International Medical


Ideal For- Younger expats looking for affordable overseas coverage with optional benefits

Need help choosing the best expat plan for you. I have partnered with expert agents with extensive international experience to assist.

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Best for Expat Insurance

travel medical insurance broker

Best For Travel Insurance

How to choose the right medical insurance coverage for you?

There are several factors to consider when choosing expat medical insurance coverage

1) Do some initial research on the country you will be living in:

What is the condition of the healthcare system in your country of residence? Are there public health plans available for foreigners? Are there any private doctors or medical care providers near the area you plan on staying in? Are prescription drugs easy to buy over the counter, or do you need to see a doctor first?

2) Look at your future health needs:

Are you a business traveler? Will you be frequently outside the country for extended periods of time? Do you have specific healthcare providers you want to include? Do you need accident insurance? Do you  have any existing chronic health conditions? Are you interested in dental benefits?

Once you understand your situation, you can narrow down the choices based on your preferences.

3) Compare different expat medical insurance companies side-by-side.

Make sure you read reviews from previous customers to learn more about each provider. Confirm the providers are financially stable and that they provide coverage with a network of hospitals and medical providers in your host country.

4) Consider the costs associated with each insurance option.

Most international medical plans are modular, with different plan levels and several add-ons or optional coverage. While some companies charge extra fees for certain services, others provide additional coverage for no additional cost.


There are several factors to consider, and making the wrong choice can be expensive. My previous article covered the mistakes expats make when choosing medical insurance overseas. This time I'm giving you specific tips you can follow to make the whole process of selecting the international medical plan much less complicated

If you need plan recommendations, read this article on choosing the best international healthcare company

Checklist of 12 International Health Plan Features You Need To Understand

Choosing a high-quality medical plan that fits your budget starts with evaluating your healthcare requirements, medical history and lifestyle. 

Next determine the right level of features, limits, coverage, and benefits to protect you and your wallet when unforeseen medical conditions occur.

Here is a checklist of 12 essential policy features to consider and what you should look for in a high-quality expat health policy.

1) Your Shared Medical Expenses

image of the true cost of an international health plan includes deductible, copay, and coinsurance

Understand the "true cost" of your medical policy, not just the annual price Image Source

There are different types of insurance costs:

  • Premiums are what most people compare when buying a family health insurance plan. These are the fees you pay monthly or annually to keep your health insurance valid.
  • Deductible is the amount of money you will pay out-of-pocket before international health insurance companies kick in. To reiterate, if you opt for a $2000 annual deductible, you are responsible for paying the total amount of your healthcare expenses until your expenses reach $2,000.
  • Coinsurance, sometimes called cost share, refers to the percentage of the medical bill you are obligated to cover after you have paid your deductible. For example, your health insurance company will pay 80% of your expenses, while the remaining 20% are your out-of-pocket costs.
  • Co-pay is a fixed fee for a specific benefit every time you use it. For instance, you are charged a co-pay for each appointment with a health professional or prescription drug bought, regardless if you've met your deductible.

When comparing international health plans based on costs, you need to pay attention to the TOTAL cost, not just what you pay each month. Compare the plan's deductibles, coinsurance, and co-pays, not just their monthly premiums.

 INSIDER TIP : In my recent article on Lowering Your International Insurance Cost, I explained why paying attention to deductibles is essential. That article details how deductible affects your international private insurance and how choosing a policy with a high deductible can lower your premium.

2) Your Overseas Health Insurance Sub-limits

Your worldwide healthcare plan may have two maximum coverage limits depending on your overseas health insurance.

  • Overall maximum limit- the entire amount your health care plan will pay or reimburse you for medical expenses.
  • Sub-limit- a maximum limit  your international coverage will pay for a specific illness or treatment (cancer treatment, pregnancy difficulties, rehab, etc.)

Check for any maximum sub-limits to your specific medical care needs to guarantee sufficient coverage. Worldwide health insurance with no annual or lifetime coverage limits sounds excellent. However, you can still get stuck with a nasty financial surprise if you don't check sub-limits.

3) Restrictions on Room Rent

Hospitals have many types of rooms: private, semi-private, and shared, from basic rooms to deluxe ones, even completely furnished luxury suites. But you do not get to pick the room you like; your room is determined by what you can pay. In some developing countries, a "standard room" means trying to recover from a painful surgery in a bare dorm room crammed with 12 other beds filled with sick people.

Many expat health plans cover your overnight stay at a hospital up to your in-patient dollar limit. However, some policies include a "standard room rent" sub-limit.

A room rent sub-limit imposes daily limits on how much you can spend on your hospital room. Many plans match your room rent to 1% of your total premium. 1% may be OK living in cheap countries like Thailand, but not Monaco, where the average cost is $3,371. A bare-bones value plan with a tiny room rent limit can result in a devastating medical bill for an extended hospitalization.

Which Countries Have The Most Expensive Hospital Stays?

RankCountryCost of hospital bed per day
6San Marino827
9United Arab Emirates711
Data Source

4) Opt for Pre and Post-Hospitalization Care

Hospital bills for a major medical procedure don't start and stop the day you enter the hospital for surgery. You'll have medical expenses before and after you enter the hospital. 

  • Pre-hospitalization expenses are any medical expenses incurred before in-patient hospital admission. X-rays, CT scans, MRIs, or any other diagnostic procedures to prep you are examples. Some insurance covers these medical expenses for up to 30 days before hospitalization.
  • Post-hospitalization expenses include any follow-up treatments, rehabilitation, additional diagnostic tests, and medication you incur after being discharged from the hospital. Depending on your insurance, medical expenses are covered for 45-90 days after discharge.

For emergency cover against financial losses, expats in countries with expensive healthcare systems need an insurance plan to cover both.

 INSIDER TIP : Work with your medical team on the timing and type of treatment and diagnostic tests you will require. Your doctors may have the flexibility to schedule your necessary procedures and scans around the limitations of your post-hospitalization care plan

5) Look For A Short Waiting Period

Pre-existing diseases, chronic diseases, and maternity benefits often necessitate a waiting period before the insurer begins to reimburse or pay for their costs. A waiting period refers to the time during which you are unable to use your overseas medical insurance policy's benefits.

Your insurer may reject any hospital bill or medical treatment claim you submit during the waiting period.

Some international health insurance companies even have an initial waiting period where you cannot make any claims for the first 30 to 90 days. Health insurers justify waiting periods to prevent you from purchasing health insurance and immediately claim a big medical expense.

Why is a low waiting period important?

Even after paying all your premiums, co-pays, coinsurance, and deductibles, your expatriate health plan may not cover your medical expenditures from day one. So, if you have a serious medical condition that requires treatment in the near future, seek a plan that is more expensive but has no or a shorter waiting time for your disease.

I recommend looking for international medical plans with no waiting time. Or make sure they fit your future lifestyle plans if waiting times exist. Ask yourself: Is the timing of your pregnancy or desire to start seeing a mental health specialist is compatible with your plan's waiting periods?

 INSIDER TIP : Exceptions To Waiting Periods- Most global insurance plans have exceptions to waive your waiting period for accidents and emergencies. For example, if you get in a car accident, many health insurers would cover your injuries, even if you are still in your initial 30-day waiting period.

Global medical plans may also waive the waiting period for certain benefits like pre-existing conditions or pregnancy if you had "prior creditable health coverage."

Prior coverage means not letting your previous global health coverage lapse, and your previous coverage was equal to or greater than your new plan.

6) Know Your International Health Insurance Plan's Coverage Limits

Besides the sub-limits I have mentioned above, annual, lifetime, and benefit restrictions limit the maximum amount your overseas health plan will allow you to claim.

  • The most typical restriction is an annual limit. All worldwide insurance policies have a maximum amount that the insurer will reimburse or pay to cover your medical expenses in a particular year.
  • A lifetime limit is the maximum amount your health plan will pay for a given medical condition over the course of your life.
  • Some policy limitations apply to certain benefits or services, as well—for example, the sub-limits covered in section 2 or the room rent limits in section 3 above.

Be aware of your coverage limit and avoid overspending on healthcare services. You will be responsible for any medical cost exceeding the limit.
Things are pretty simple: the smaller your insurance coverage limit, the lower the cost of your international meidcal plan, and the more your insurance payment, the larger your coverage limit.

7) Coverage For Day Care Treatments

Most expat health insurance plans cover in-patient care, including major surgeries that require overnight hospitalization, which is some of the priciest procedures in healthcare. 

However, quick medical procedures, such as chemotherapy or dialysis, can be done in a day. These treatments are called day care. Day care can also include surgeries like removing your tonsils or draining your knee that do not require you to stay in the hospital overnight.

Day care procedures can get very expensive, and coverage for daycare treatments varies depending on the insurance company.

Why is day care coverage important?

  • Day care procedures do not require you to stay in the hospital for 24 hours, but that does not mean they are cheap.
  • A standard dialysis averages $500 per session, soaring to over $10,000 per month in outpatient costs.
  • Day care may be considered outpatient care and is not covered by all global health plans or may only provide partial coverage for day care treatments.

8) Bonuses If You Don't Make A Claim

Did you know the more claims you make, the higher your health insurance costs get when you renew the next year? All insurance companies base their business on probability. Their statistics say if you make a claim, even if it is 100% valid, you are more likely to make additional claims in the future. 

Some health insurance policies reward clients with bonuses or discounts if they don't make any claims for 12 consecutive months.

  • A bonus is when they increase your coverage limits. For example, increasing your maximum plan limits from $500,000 to $550,000.
  • A discount is when they reduce the premium you pay. For example, lowering your annual insurance premiums from $2000 per year to $1800.

Staying healthy is a win-win for everyone.

The healthier and more fit you keep yourself, the less you need to see a doctor. The less you need to see a doctor, the less you will claim on your insurance plan. The less you claim on your plan, the more money your insurance company makes. It only makes sense that your international health plan encourages you to stay healthy and not make any claims.

Some international medical plans even offer cumulative bonuses so that the bonus builds for each year to you don't make a claim.

9) Free Look Period

Have you ever bought something, then found a better deal a few days later? Or have you ever had buyer's remorse after a purchase, realizing you wanted something different? A global health plan with a "Free Look Period" is made for people like you.

This time period allows you to cancel your international health plan without penalty and get a full refund before a certain number of days pass. Of course, this is not an opportunity for you to buy an insurance plan, ring up a bunch of medical expenses, and then ask for your money back. 

A Free Look Period only works if you haven't made any claims and your health insurance company has not guaranteed any payments.

10) Includes Preventative Care

International health insurance protection typically only includes coverage for accidents or emergency benefits for severe medical issues. You may be surprised that your medical assistance benefits don't cover preventive care such as check-ups, vaccines, and routine exams.

What is preventative care?

Preventive services, also known as wellness benefits, try to reduce your risk of potentially serious medical conditions by detecting them early before they become serious.

Preventive care is a progressive and holistic approach to combat rising healthcare costs by focusing on preventing sickness and disease, not just treatment. Preventative care can include annual exams, routine screenings, scans, and vaccinations and sometimes extend to free or subsidized gym memberships or appointments to see a registered dietitian.

Makes sense for everyone to prevent serious illness and keep the cost of health care benefits low. However, for some reason, most insurers only offer preventative care as a supplemental benefit requiring an additional premium.

Examples of Well-Being Resources and Coverage

  • Adult Preventive Care: Health check-ups, HIV testing, and colorectal cancer screening
  • Female Wellness Exams: mammograms, neonatal screening, gynecological exams, Osteodensitometry/bone-density scans
  • Older Expats Preventive Healthcare: Cholesterol, Cancer, and diabetes screening, hearing problems, Age-specific immunizations

Most entry-level expatriate health plans include illness and emergency treatment as part of the basic benefits. However, basic coverage excludes preventive medicine, even if the cost of preventing the sickness is less than the cost of treating the illness.

A perfect example is if you are bit by a mosquito in Thailand and then catch a bad case of yellow fever. Your expat health plan will pay for a Thai hospital overnight stay to receive medical care. However, your expat health plan would not cover a cheap yellow fever vaccine, as a vaccine is considered preventative medicine. Insurance logic is not always logical.

11) Repatriation and Medical Evacuation Flights

Most expats would not think this service is important, but in my opinion, this international insurance benefit gives me the most peace of mind. 

An evacuation flight is your 24/7/365 "oh crap, things are getting serious" contingency plan. These "oh crap" events can run upwards of $150,000 - $300,000. These are the types of events that bankrupt you, drain all your savings accounts, and cause people to set up GoFundMe charity drives.

cost of medical evacuation from different countries that are covered by your international medical plan

Medical transportation providers charge up to $225,000 for emergency flights from Asia, Australia, or the Middle East to the USA Image Source

A quality health insurance international plan arranges for a creditable evacuation company to transport you if you require medical attention that cannot be treated locally.

What is medical evacuation?

If you have a life-threatening emergency, emergency medical evacuation is the process of evacuating you to the closest country where you can receive appropriate medical treatment.

If you reside in a developing country where medical treatment may be below western standards, air ambulance service coverage is critical.

Some expatriate health insurance policies will include some level of medical emergency evacuation and repatriation as part of basic coverage. Other expat plans require purchasing repatriation and evacuation as an optional add-on benefit.

What is medical repatriation?

While very similar to medical evacuation, medical repatriation is the cost of being transported home if deemed medically necessary. However, the flight doesn't need to be a medical emergency like the evacuation flight.

You may be repatriated back to your home country if access to specialist care is not available where you are being treated. For example, if you need a specific kind of joint replacement that is only available in your home country.

 INSIDER TIP : Travel Health Insurance Plans- I recommend against any expat relying solely on travel insurance for healthcare. The critical flaw to using travel insurance is that you must maintain a separate health insurance policy in your home country.

Your travel medical insurance provider will always look for their most affordable option, regardless of the impact on you. If your injuries or illness are severe, your travel medical insurance provider has the choice to fly you back to your home country for further treatment. Once your medical repatriation is paid for, their responsibility ends. The remainder of your medical expenses is your and your home insurance's responsibility.

What is non-medical evacuation?

If you need to leave the country for a national emergency, your international family health insurance is your vital lifeline to the nearest safe location. You may think these are rare occurrences, but there have been several in recent history affecting expats:

  • War breaking out in the Ukraine war in 2022
  • Nationwide health crises causing the pandemic lock downs of 2020
  • Natural disasters such as the Thailand tsunami in 2004

What is the repatriation of remains?

Repatriation of remains is the process of returning a deceased person's body or cremated remains back home. The cost of repatriating a dead body depends on the country but ranges between $4,000 and $10,000.

This unfortunate situation is a terrible thing to consider. Still, I've seen expat families in Vietnam and Cambodia struggle to get their children's bodies home after a fatal motorbike accident.

12) Cover for Alternative treatments

What is Alternative Medicine?

Alternative medicine, also referred to by health insurance companies as complementary and alternative medicine(CAM), are holistic medical remedies focusing on treating the root cause of health problems rather than the symptoms.

There are different types of alternative medicine, including acupuncture, massage therapy, herbal remedies, yoga, meditation, and other forms of exercise. Acupuncture and Traditional Chinese Medicine are the most popular, but chiropractic care and homeopathic medicine are also common. Some believe that certain alternative treatments can prevent or cure diseases.

Do I need Alternative Medicine coverage?

Alternative medicine is a broad category of healthcare practices that aren't part of conventional medicine. They're often called complementary and alternative medicine (CAM). While the term is "alternative" treatments, they are more used as complementary to Western medicine rather than a substitute for seeing a doctor.

If you are interested in alternative treatments, your insurer might have a policy that covers them. Some insurance plans will partially or fully cover specific therapies like acupuncture or traditional Chinese medicine. Basic expat health plans rarely include access to alternative medicine. However, CAM may be an optional add-on to an expat policy's outpatient benefit.

Key Takeaway: International Medical Plan Checklist

Buying expat insurance coverage is a critical part of planning your move abroad. It doesn't have to be complicated or expensive. However, the fine print of the health insurance contracts matters.

There are several factors you need to understand. Use the information from this checklist to help you figure out which clauses in your policy hide critical information that can be costly to ignore.

Once you've sorted all of these details, you're ready to shop for the best plan available. Here is my post with the best international health insurers to help you sort things out. Or you can click here to get up to five free quotes from companies offering award-winning international health insurance plans.

Remember, though, that shopping around doesn't mean that you have to pay top dollar. There are plenty of ways to help you reduce the cost of your expat health insurance


Other helpful resources on insurance for expats

A Comprehensive Guide To Philippines Health Insurance For Expats
24 Facts About Healthcare In The Philippines Every Expat Must Know
How To Get Health Insurance In Colombia As A Foreigner

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