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International Health Insurance for Expatriates and Students: A Worldwide Review is a report and market data file about the global market for health insurance and related cover sold to expatriate and student customers, which is estimated by Finaccord to have been worth almost USD 13 billion in terms of total gross written premiums and around USD 2.78 billion in terms of new business in 2015.

Using its proprietary International Health Insurance Market Data Model, Finaccord reports on the size and segmentation of this market in a number of ways:

- by region and major country of origin with data available separately for Africa, the Asia-Pacific region, Australasia, Europe, Latin America, the Middle East and North America as regions of origin, and for Brazil, Canada, China, France, Germany, India, Japan, the UK and the US as major countries of origin;

- by destination region with data available separately for Africa, the Asia-Pacific region, Australasia, Europe, Latin America, the Middle East and North America;

- by type of customer with a breakdown between individual workers, corporate / other transferees (including diplomats and employees of charities and NGOs), students, retired individuals and other customers (defined as non-employed spouses and children).

Moreover, the market is quantified in terms of total and new business not only in 2015 but also for 2011 and forecast to 2019, thereby illustrating growth trends by region and major country of origin, destination region and customer type. In addition, data is provided for the same years and segments for the number of international health insurance policies sold and for the total number of eligible consumers (i.e. including expatriates and students who have not taken out this type of insurance). This means that the implied penetration rate for international health insurance can be calculated by region and major country of origin, destination region and customer type, thereby illustrating the potential for the market to grow further.

Finally, key underwriters and intermediaries of international health insurance are identified within each regional and country-specific analysis.

Note: the nine major countries of origin are estimated to have accounted for 60.4% of the total worldwide market value in 2015 – similar data for other countries can be generated on request (as a separate, bespoke exercise).

Key findings from the executive summary include:

- there were a total of 105.1 million expatriates and students worldwide eligible for international health insurance in 2015 and this number grew at a compound annual rate of 3.3% between 2011 and 2015 from a total of 92.4 million in the prior year;

- the global market was worth around USD 12.98 billion in gross written premiums in 2015 of which around USD 2.78 billion was due to new policies bought in 2015 itself;

- Finaccord predicts that the total number of policies in force is likely to rise at a compound annual rate of 4.2% between 2015 and 2019 while new policies are expected to rise at an equivalent rate of 6.1% over the same period;

- however, as a result of rising average policy prices, future growth in the market value is likely to be substantially higher;

- specifically, a compound annual rate of 11.7% is forecast for the total market value from 2015 to 2019 and one of 13.0% over the same time frame for new business – this would produce a market worth around USD 20.20 billion in 2019, within which around USD 4.53 billion would be due to new business.

Table Of Contents

International Health Insurance for Expatriates and Students: A Worldwide Review


TABLE OF CONTENTS
00 EXECUTIVE SUMMARY 1
10 INTRODUCTION 6
What is this report about? 6
This report is focused on a market with a global value of almost USD 13 billion in 2015… 6
… segmenting it by customers' region of origin, destination region and type 6
Rationale 6
International health insurance may be characterised as a fast-growing yet complex market 6
Methodology 7
Eligible customers (expatriates and students) 7
Market data 7
External sources 8
Definitions 8
International health insurance 8
Eligible customers (expatriates and students) 9
Individual workers 9
Corporate and other transferees 9
Students 9
Retired individuals 9
Others 10
Regions 10
Other terms 10
Finaccord 10
20 GLOBAL OVERVIEW 12
Market overview 12
Eligible expatriates and students 12
The global total of eligible customers for international health insurance exceeds 105 million… 12
Number and value of policies 13
… although only a small proportion of these have acquired this type of cover 13
The value of the worldwide market has been increasing at a compound annual rate of more than 11% 13
… and is on track to exceed USD 202 billion by 2019 13
Regions of origin 15
Number of eligible expatriates and students 15
Countries in the Asia-Pacific region produce almost a half of all eligible expatriates and students 15
…and a slightly higher share of customers that become eligible in any given year 15
Number of policies 17
Policyholders originating from European countries are most numerous in total… 17
…although the largest share of new policies is generated by customers from the Asia-Pacific region 18
Value of policies 20
Three regions of origin generate the lion's share of the total global market value… 20
… and also the value of new business that becomes available each year 21
Destination regions 23
Number of eligible expatriates and students 23
The Middle East is the most common destination region for eligible customers… 23
… followed by Europe and North America 24
Number of policies 26
Individuals going to North America account for the most policies in force and new policy sales… 26
…but with those migrating to Latin America generating the fastest growth by both measures 26
Value of policies 29
Policies sold to eligible customers heading for North America generate the high value of premiums 29
Types of eligible expatriates and students 31
Number of eligible expatriates and students 31
Most eligible customers are classifiable as individual workers 31
Number of policies 34
…although this group holds a much lower share of policies… 34
…and are overtaken by students when it comes to the split of new policy sales 35
Value of policies 37
Individual workers and retired individuals constitute the two largest categories by total value… 37
…although students become more prominent in the analysis of new business 37
Leading competitors 39
A handful of underwriters are globally significant in the market for international health insurance… 39
…with a few intermediaries also having attained this level of prominence 40
30 AFRICA 41
Introduction 41
Regional overview 41
Eligible expatriates and students 41
Africa has a relatively mobile population 41
Over 90% of eligible customers from Africa head to other African countries or the Middle East 43
Individual workers account for the vast majority of the total… 45
Number of policies 48
Take-up of international health insurance policies is very low among eligible customers from Africa 48
Insurance take-up rates among eligible individuals from Africa are generally low 50
Most policies sold to eligible individuals from Africa are bought by students 52
Value of policies 54
Premiums are growing rapidly, especially due to movement of eligible Africans to North America… 54
Intra-regional migration within Africa accounts for the highest share of the market value 56
Comparison of eligible expatriates and students, number and value of policies 61
Student policies are most significant numerically, although in terms of value the split is relatively equal 61
Key competitors 63
Bupa International, Cigna and MAPFRE have launched Africa-specific products in recent years… 63
…joining South Africa's Momentum Health in this context 63
Brokers based in Kenya are especially prominent among intermediaries 64
The student market is particularly important in South Africa, and health insurers respond accordingly 64
40 ASIA-PACIFIC REGION 65
Introduction 65
Regional overview 65
Eligible expatriates and students 65
The Asia-Pacific region is one of the fastest-growing sources of eligible individuals in the world… 65
…with India the most significant single source of them by outright number 66
Most eligible consumers from the Asia-Pacific region head to the Middle East as a destination region… 67
… and the vast majority are individual workers 69
Number of policies 71
The regional take-up rate among eligible expatriates and students is comparatively low 71
China generates the most policy sales of any country in the Asia-Pacific region 71
New policy sales during the year account for over 40% of total policies in force in any given year… 72
Almost a half of all insured customers from this region have moved to North America 73
… which is mainly a consequence of the importance of the student market in the Asia-Pacific region… 75
… and very low take-up rates among individual workers 77
Value of policies 77
Premiums have been growing rapidly and that growth is likely to accelerate up to 2019 77
North America is by far the most important destination region in terms of the value of cover bought 79
In terms of total premiums, the Asia-Pacific market divides quite evenly across the five customer types… 81
…albeit students account for over 50% of new business 82
Comparison of eligible expatriates and students, number and value of policies 84
By both volume and value, retired individuals constitute the smallest customer segment in the region 84
Key competitors 86
Hong Kong is an important hub for international health insurance business in this region… 86
…as are Malaysia and Singapore, albeit to a lesser extent 87
China 88
Eligible expatriates and students 88
There are close to 6 million expatriates and students from China eligible for international health insurance 88
… many of whom have moved (or are moving) to the US 88
Most consumers from China eligible for international health cover are either individual workers or students 90
Number and value of policies 92
As elsewhere, the value of the insurance market has been growing more quickly than the volume 92
International health insurance policies are also sold to more affluent individuals in China itself 93
Over a half of all policies sold to Chinese expatriates and students are for those going to the US… 94
… and the importance of the student market is clear from the analysis by customer type 96
The volume of sales is growing at double-digit compound annual rates for most destination regions… 98
… and for most customer types 100
Comparison of eligible customers, number and value of policies 102
An overall analysis emphasises the primary importance of students as customers for this type of cover 102
Key competitors 104
A number of major international health insurers operate through joint ventures in China… 104
Several entities focus specifically on the Chinese student market… 105
… and others on higher net worth customers in China itself 105
India 106
Eligible expatriates and students 106
The number of eligible expatriates and students from India has grown consistently in recent years… 106
…with a very clear majority moving to countries in the Middle East… 106
… especially individual workers, who dominate the analysis of eligible consumers by customer type 108
Number and value of policies 111
Between 2011 and 2015, international health insurance bought by Indians delivered little growth… 111
…with decreasing migration to the US likely to have been a major cause in this respect 112
Indians moving to Europe and North America are the most likely to buy international health cover 113
Students account for around one half of total international health insurance policies in force… 115
… which is a result of the very high take-up in this category compared to the other four customer types 116
A breakdown by premiums shows North America to be the most significant destination region 118
Corporate and other transferees account for the highest value of new business sold each year in India… 120
Comparison of eligible customers, number and value of policies 122
… in spite of the fact that they are a numerically small group in terms of total eligible individuals 122
Key competitors 124
Relatively few India-based companies target eligible expatriates and students from that country 124
Hanna Global Solutions serves over 100,000 Indian nationals living in the US 124
Policies targeted at students tend to be configured as travel insurance rather than international health cover 125
Japan 126
Eligible expatriates and students 126
Growth in Japanese migrants is expected to accelerate between 2015 and 2019… 126
…with North America remaining the most important destination region 126
IV

Individual workers represent the largest group in terms of total number of eligible consumers… 128
… but they are overtaken by students in terms of newly-eligible consumers in any given year 128
Number and value of policies 131
Around 400,000 policies have been sold to eligible expatriates and students from Japan 131
…with most among those going to North America or other countries in the Asia-Pacific region 132
By destination region, take-up rates are likely to vary from just under a half to almost two thirds 133
Individual workers account for over 50% of all international health policies held by Japanese customers 135
Take-up rates peak among students plus corporate and other transferees 136
In value terms, North America dominates the segmentation of the market by destination region… 138
… which, as elsewhere, is a consequence of the high cost of healthcare there, especially in the US 138
One customer type accounts for over two thirds of the total market value 141
Comparison of eligible customers, number and value of policies 143
Policies for individual workers from Japan are far more important than for other Asia-Pacific countries 143
Key competitors 145
Japan-based insurers are more likely to provide cover for international students than other expatriates… 145
50 AUSTRALASIA 146
Introduction 146
Regional overview 146
Eligible expatriates and students 146
Australasia is one of the most rapidly growing sources of consumers eligible for international health cover 146
The majority of migration out of Australia and New Zealand is intra-regional… 148
…although destinations further afield have tended to show higher growth… 148
… with individual workers especially important in this context 150
Number of policies 152
Intra-regional movement means policy take-up rates are lower than might be expected… 152
…although this situation is likely to change over time as longer-haul destinations grow in popularity 153
Take-up rates are high among all eligible customers apart from those moving within Australasia itself 154
Corporate and other transferees account for the smallest number of policies in force… 156
… but are likely to feature the highest take-up rate 156
Student take-up rates in Australasia are the lowest of any region in the world 158
Value of policies 159
Boosted by migration to North America, international health insurance premiums are growing rapidly… 159
…with almost a half of the market's value due to customers moving to that destination region 161
The bulk of the total and new market value is attributable to individual workers… 163
Comparison of eligible expatriates and students, number and value of policies 166
… as is evident from the comparison of the five customer categories across the six key metrics 166
Key competitors 168
Over a dozen underwriters and intermediaries of international health insurance are prominent… 168
… and a wide range of providers focus on insurance to meet Australia's visa requirements 169
60 EUROPE 170
Introduction 170
Regional overview 170
Eligible expatriates and students 170
Europe is a major and growing source of consumers eligible for international health insurance… 170
…with the UK the largest single source country in this respect 171
The vast majority of eligible individuals from Europe are based in other European countries 172
Individual workers account for over 70% of all eligible consumers originating from Europe… 174
… albeit for a lower proportion of newly-eligible ones in any given year 174
Number of policies 176
France, Germany and the UK are likely to account for over half of all policies held by Europeans… 176
…with increasing migration to destinations outside of Europe helping to boost policy sales 177
Take-up rates are high for all destination regions apart from for eligible customers moving within Europe 178
V

Value of policies 183
The value of cover sold to Europeans is predicted to rise by over 50% between 2015 and 2019… 183
…with North America and other countries in Europe the most important destinations in this respect 185
… and double-digit compound annual growth rates forecast for all customer types apart from one 187
Comparison of eligible expatriates and students, number and value of policies 190
Retired individuals account for a share of the market value that is high in comparison to their number 190
Key competitors 192
A number of underwriters are generally prominent in the European market 192
MAPFRE Asistencia began working with the Erasmus student exchange program in July 2015 193
France 194
Eligible expatriates and students 194
Over 220,000 individuals from France became newly eligible for international health cover in 2015… 194
… although just over a half of these moved to other European countries 194
Individual workers and students together account for over three quarters of all eligible consumers… 196
…with students growing to almost a third of newly eligible ones 196
Number and value of policies 198
Growth in sales of international health insurance policies is expected to increase from 2015 to 2019 198
…with policies held by those going to North America the most prevalent… 199
…and intra-European policies comparatively rare 200
The take-up rate among individual workers from France is not especially high… 202
… but almost two thirds of all policies in force are held by them 202
French expatriates and students heading to North America account for over a half of the market value… 205
… whether measured in overall terms or in terms of new business 205
The significance of individual workers becomes clearer when the market value is split by customer type 207
Comparison of eligible customers, number and value of policies 209
Retired individuals represent the smallest opportunity by most measures 209
Key competitors 211
The CFS provides a significant level of coverage for French expatriates and students… 211
… which means that many providers offer ‘top up' cover as well as ‘from the first Euro' cover 211
There are numerous intermediaries of international health cover operating out of France… 212
…and a number of mutual insurers and assistance firms also have relevant propositions 213
Germany 215
Eligible expatriates and students 215
Eligible consumers from Germany have grown at a slower rate than other countries in Europe… 215
…and over two thirds of them simply move to other European countries… 215
…albeit this proportion will decline in future given rapid forecast growth rates to Africa and Latin America 215
Retired individuals represent a relatively high proportion of eligible consumers from Germany 217
…although students constitute almost a third of those moving in any given year 218
Number and value of policies 220
Growth in policies held by German expatriate and students has been hesitant… 220
…although increasing average prices have ensured growth in the market value 220
Take-up rates range from around 60% to 85% among Germans migrating outside of Europe… 221
… but are vastly lower among those who move within Europe 222
Almost two thirds of international health insurance policies are held by individual workers 224
In spite of its low take-up rate, Europe is the second-largest destination region by market value… 226
… although it lags far behind North America 226
When the market value is split by customer type, retired individuals come second to individual workers 228
Comparison of eligible customers, number and value of policies 230
Corporate and other transferees constitute the smallest segment by most measures 230
Key competitors 232
Germany-based underwriters of international health cover include Allianz, DKV and HanseMerkur… 232
… and around ten intermediaries of this type of insurance enjoy considerable prominence 232
Other competitors include insurance aggregators… 233
VI

… and firms specialising in student health insurance 233
UK 234
Eligible expatriates and students 234
The overall number of eligible consumers from the UK declined between 2011 and 2015… 234
… albeit their destinations are more diverse than for their counterparts elsewhere in Europe… 234
…and the overall trend is towards destinations outside both Europe and Australasia 234
Retired individuals make up a particularly high proportion of eligible consumers from the UK… 236
…both in terms of their overall number and the newly eligible number in any given year 237
Number and value of policies 239
Close to one million international health insurance policies are in force among customers from the UK 239
The value of this market has been growing far more quickly than the volume of it 239
Four destination regions are roughly equal in importance when policies are segmented by region… 240
…and cover is rarely bought by those heading to other European countries 241
As in France and Germany, the individual worker category accounts for the most policy sales… 243
… even though its take-up rate is probably the fourth-highest out of the five customer groups… 243
… ahead only of that of retired individuals 244
Policyholders going to the Middle East and North America together account for over a half of premiums… 246
… and the split by new business does not vary much from that for total business 246
Since their policies are relatively costly, retired individuals account for a large chunk of the market's value 248
Comparison of eligible customers, number and value of policies 250
Students constitute a fairly small opportunity whether measured in volume or value terms 250
Key competitors 252
Numerous intermediaries of international health insurance are based in the UK 252
Healix International manages healthcare services for around 23,000 UK government employees 253
Policies targeted at students are generally configured as annual travel insurance products 254
70 LATIN AMERICA 255
Introduction 255
Regional overview 255
Eligible expatriates and students 255
Growth in eligible consumers originating from Latin America will rise between 2015 and 2019… 255
…with Brazilians comparatively unimportant within the regional total 256
Over a half of the target audience from Latin America goes to North America but Europe is also important 257
The vast majority of eligible consumers from Latin America are classifiable as individual workers 259
Number of policies 261
The take-up rate across all eligible consumers from Latin America is likely to be just over 6% 261
The market for new policy sales is growing more rapidly than the total number of policies in force… 262
… as a result of the rising importance of corporate and other transferees plus students 263
Take-up rates are held back by the high weighting of individual workers within all eligible customers 263
Students account for the vast majority of both total policies in force and new policy sales… 265
… because the take-up rate among them is much higher than in most other customer groups… 265
… which is itself caused by the fact that many travel to study in the US 267
Value of policies 268
Rapid and accelerating growth in the value of the market is forecast for Latin America as a whole 268
Insured customers heading to North America account for the vast majority of the market value 270
By customer type, international health insurance premiums break down quite evenly… 272
…although student policies account for nearly a half of new business 273
Comparison of eligible expatriates and students, number and value of policies 275
The vast majority of eligible individual workers migrating out of Latin America are uninsured 275
Key competitors 277
Key providers include GNP Seguros, Lockton, Pan-American Life, Redbridge International and VUMI 277
Brazil 279
Eligible expatriates and students 279
The total number of eligible consumers from Brazil contracted between 2011 and 2015… 279
VII

… mainly as a result of a sharp reduction in the number of Brazilians in Europe 279
North America's significance as a destination is likely to increase while that of Europe drops further 279
Individual workers dominate the breakdown of the total number of eligible consumers from Brazil… 281
…but students dominate that for newly eligible individuals 281
Number and value of policies 283
Although the target audience has shrunk, policies in force and new policy sales have increased 283
…driving growth in premiums 283
Brazilians heading to North America and Europe account for the lion's share of insurance policies… 284
… and an overwhelming proportion of these are bought by students 286
A similar pattern is apparent when the market value is split by destination region and customer type… 288
… albeit in the latter case, corporate and other transferees are also quite significant 290
Comparison of eligible customers, number and value of policies 292
Students dominate the Brazilian market, especially when considered in terms of new business 292
Key competitors 294
Group Saúde, Neoserviços and Panamed Saúde are notable local providers… 294
… and several firms focus on selling travel cover specifically designed for students 294
80 MIDDLE EAST 296
Introduction 296
Regional overview 296
Eligible expatriates and students 296
The number of eligible expatriates and students from the Middle East is likely to exceed 5 million by 2019 296
Most individuals leaving countries in the Middle East move to other countries in the region… 298
…although students are an exception, with a large majority heading to North America 298
By customer type, individual workers constitute the dominant category 300
Number of policies 302
Across all eligible individuals from the Middle East, the take-up rate for international health cover is low… 302
…although the market grew quite strongly between 2011 and 2015 and will continue to do so up to 2019 303
The vast majority of policies are sold to expatriates or students moving to North America 304
When broken down by customer type, the vast majority of policies are found to be held by students… 306
… with over 90% of new policy sales likely to have been made to this group in 2015 308
Value of policies 308
International health insurance premiums due to buyers from the Middle East have also risen quickly… 308
…with those sold to cover expatriates and students moving to Europe having grown most quickly 310
… and this has been the case for all customer types, not just students 312
Comparison of eligible expatriates and students, number and value of policies 315
Both the volume and value of the Middle Eastern market are strongly oriented to students 315
Key competitors 317
Affluent residents in the Middle East are also buyers of international health insurance policies 317
Numerous providers target expatriates from other regions based in the Middle East… 317
… and these include intermediaries as well as underwriters 319
90 NORTH AMERICA 320
Introduction 320
Canada 321
Eligible expatriates and students 321
The number of Canadians eligible for international health insurance is likely to continue rising 321
The Asia-Pacific region, Europe and the Middle East are the most popular destination regions 321
Individual workers are dominant when the total number of eligible consumers is broken down… 323
… and they are also most prominent in the analysis of newly eligible individuals 323
Number and value of policies 325
Relatively strong growth is predicted for the number of policies covering Canadian expatriates… 325
…driving even stronger growth in terms of premiums 325
The geographical distribution of policies largely echoes that for the destinations of the target audience 327
VIII

Individual workers are likely to account for over 70% of the total number of policies in force… 329
…although students and corporate / other transferees are the most rapidly growing categories… 329
… and these also feature the highest implied take-up rates 330
As with eligible customers and policies, the premium breakdown by destination region is diverse… 332
… with Canadians heading to the Middle East likely to represent the largest single segment 332
By 2019, expenditure by Canadians on international health cover is likely to be close to USD 750 million… 334
… with most of this still bought by individual workers… 334
Comparison of eligible customers, number and value of policies 336
… who constitute the most prominent customer group across all six metrics analysed 336
Key competitors 338
Around half a dozen Canada-based underwriters promote international health insurance… 338
…as do over 20 intermediaries 338
US 340
Eligible expatriates and students 340
In terms of outright number, eligible US consumers add up to one of the world's largest target markets… 340
…with the Asia-Pacific region the most popular destination, followed by Europe… 340
…albeit with migrants to Latin America growing most rapidly 340
Students are more visible in the analysis of newly eligible consumers than that for all eligible consumers 342
Number and value of policies 344
The US market for international health insurance is the largest in the world… 344
…and its growth is likely to accelerate between 2015 and 2019 345
US migrants to the Asia-Pacific region account for a majority of policies sold… 346
…although the take-up rate may be even higher among those going to Latin America and the Middle East 346
Implied take-up rates exceed 70% across all five customer groups… 348
… peaking at more than 85% among corporate and other transferees… 348
… which is partly because the US lacks reciprocal healthcare agreements with other countries 349
Eligible customers migrating to the Asia-Pacific region account for close to a third of the market value… 351
… and individual workers for the vast majority of it… 353
Comparison of eligible customers, number and value of policies 355
… which reflects their general dominance in the broader analysis by customer type 355
Key competitors 357
Many of the most prominent international health insurers are based in the US… 357
…along with a wide range of health and travel intermediaries… 358
… and a few providers with propositions specific to students 359
IX

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