Industry Profile

Finger on the pulse

ITIJ 222, July 2019
David Allen
Underwriting Strategy Manager
Direct Line

ITIJ caught up with David Allen, Underwriting Strategy Manager at Direct Line in the UK, to talk underwriting, tech, personalisation and more


How did you first get started in the insurance industry, and how did you come to be in your current role?

I started in insurance in 1987 with Commercial Union (CU). As with many people in the industry, I wasn’t really sure what I wanted to do when I finished education, but I knew people at Eagle Star, General Accident and Norwich Union and they all seemed to be doing well so I wrote nine letters (no CV) and got four job offers – CU paid the most so I chose them!

I had a variety of roles at CU and through its metamorphoses – CGU, Norwich Union and Aviva – including commercial lines underwriting, broker account management, marketing and personal lines product development, and finished there in 2009 when Aviva withdrew from the site at which I worked.

After a period out, in 2010 I had the opportunity to join what was then RBS Insurance, now Direct Line Group (DLG) to underwrite travel. I had had a broad experience at Aviva, but travel was new to me.

Following a restructure of the underwriting team in 2016, I joined the new strategy underwriting team to focus on future challenges and developments across all products and haven’t looked back. Even though I am no longer solely working on travel, it is still a product I care passionately about within DLG and as Chair of the ABI Travel Committee.


Your insurance industry experience covers a range of segments and product types – would you say that travel poses more complex challenges than others?

Every product has challenges but I have always felt that travel is the most complex personal lines product you are likely to buy, because it caters for lots of types of cover (medical, trip covers like cancellation, liability, property, legal expenses, and so on). If you read any other product, it is relatively easy to compare, and cover names are largely the same with the difference in the detail. The variation in different customer outcomes at point of claim is usually as a result of differences in claims approach or the ways in which some of the covers and exclusions work, which is much more subtle than home or motor, for instance. This opacity means that while many customers may know they need it, they may not necessarily know why or how important it is to select wisely and understand what is and is not covered.

Travel also contains the biggest moment of truth you can face as a customer – being ill abroad, potentially with language barriers. Unfortunately, there are too many instances, some of which we read about weekly in the media, where insurers have let their customers down.


What technological advancements would you say have particularly revolutionised the underwriting space?

Medical screening, especially online, has made a big difference to the underwriting of risks, meaning more customers are able to get appropriate cover than ever before. This does still rely on them to read and understand the health questions they are asked, though, and answer truthfully.

Additionally, the growth of price comparison websites has enabled customers to access a wider market more easily, although this does come with the challenge that customers should not necessarily just pick the cheapest product – there is no point paying for insurance if it won’t pay you back when you need it most.


How does Direct Line keep up with consumer demands for personalised travel cover and swift claims processing – all at the touch of a button?

We are investing heavily in our technology by building our own bespoke system, which will enable all kinds of innovation in our future. This will enable us to provide great customer service with minimal disruption. Consequently, we will have much better data, which will enable us to review our offering to make sure we can meet customer needs and expectations. We also invest heavily in our people. While we are very keen to give customers the opportunity to self-serve, especially for the simplest interactions, it is important that customers can speak to a real person when they have something complex to deal with, or just need some help.


How do you see the travel insurance industry further developing its underwriting capacities in the coming years?

The recent publication of statistics from the ABI reveals the challenges of upward pressure on claims costs allied with downward pressure on premiums, which is a huge challenge. Add in to the mix the uncertainties around Brexit, interest from regulators (such as the FCA work on access to insurance) and the opening up of new destinations off the beaten track (in Asia, South America and Africa) and activities (especially cruises) and there is plenty to keep us underwriters occupied.

Underwriters need to keep up with regulatory issues for both insurance and the travel industry (such as denied boarding regulations or package travel regulations), customer dynamics, and risks and opportunities from new technologies and entrants to make sure their offerings do as they are expected to.


How has Direct Line been preparing its insureds, potential customers and its business operations for Brexit?

The lack of certainty with Brexit is challenging to all businesses. Most of our customers come to us via our brand partners and we have had conversations with them about what to expect from us. Our products that are already in circulation will continue to provide certainty for all our customers regardless of whether, when and how we exit from the EU.

Unlike some other providers, we do not mandate the compulsory use of the EHIC, so any impact would likely be smaller than on some others, assuming travel providers such as airlines can continue to operate as we have been led to believe.


Can you describe a typical day as Underwriting Strategy Manager?

My role is threefold – partly it is understanding and responding to legal and regulatory challenges, partly working on strategic development opportunities and threats, and partly involvement in tenders for new and existing partnerships. As this is across all the personal lines product types DLG underwrites, I get lots of variety, which is really interesting for me. No two days seem the same.


Which aspects of your role do you enjoy the most, and which are the most challenging?

I am very lucky to work with some talented people, which is great as I really enjoy team working. Luckily, I like all the different facets of my role and like getting into detail, so even reading the EU General Data Protection Regulations wasn’t a chore.

The biggest challenge is trying to prioritise all the many things that need doing and stopping myself from focusing on the most exciting at the expense of the most important.  


If you could invite any three people, living or dead, to a dream dinner party, who would you choose?

It is always tempting to pick great intellectual names such as Sir David Attenborough, Barack Obama, Sir Winston Churchill or Mahatma Gandhi, or raconteurs and entertainers such as Oscar Wilde or Tom Hanks, but in truth, I would like two dinner parties. The first would be with three dead people – my mum and dad and my dad’s sister who brought my parents together back in 1956; I never witnessed them all in the same room and I know that would be fun and very enlightening.

The other party would be with three living people: my children, who are 27, 23 and 22. In both cases, because you can never have enough time with those you love.


Every product has challenges but I have always felt that travel is the most complex personal lines product you are likely to buy
Feature category: 

Thinking globally

ITIJ 220 | May 2019
Antoine Parisi
Europ Assistance

Antoine Parisi, CEO of Europ Assistance, talks to ITIJ about the contemporary assistance landscape, the importance of maintaining strong networks, and the potential of new technology

How did you first get started in the assistance industry?
I initially began my career in the insurance industry as an actuary before coming to the assistance sector, so insurance has always been a part of my background. Over time, I gravitated toward the assistance industry, as it offers a personal connection with the customer, like a helping hand, rather than a purely financial product. Increasingly, insurers see the huge value assistance plays for them, such as the regular touchpoints with customers and insights on customer behaviour and loyalty. It’s also incredibly varied; we play a clear role for insurance companies but also a huge range of other sectors, making it almost limitless in potential. 
New technology is changing the way insurers, assistance companies and all participants in the value chain are doing business. How is Europ Assistance leveraging new technology in order to improve its service proposition? 
It’s not just insurance and assistance, it’s every sector. There’s no denying that technology can be disruptive, but Europ Assistance has been, and will continue to be, well prepared to take advantage of the opportunities that disruption presents. Thanks to changes in technology, we can offer more and better quality services to more people. 
Firstly, new services exist today that simply couldn’t have been offered before: cyber  protection; our senior care approach, which utilises a digital match-making service to ensure you get the right caregiver; IT assistance; digital health trackers such as our MyClinic product; and telemedicine. These developments are shaping and diversifying our business. 
There’s also been a significant change in our core traditional businesses – travel and automotive. In travel, we now have e-claims, which is simplifying the claims process. In automotive, we have digital roadside assistance, which utilises new technology to give the customer a clear idea of how we are helping them, giving them more control of the service. Additionally, our virtual agents help us manage peak periods in ways that were previously unimaginable. 
Finally, and this is especially true in travel, our customers are changing. Companies have emerged that previously didn’t exist; the OTA segment is a great example. The creation of this segment has impacted traditional travel businesses – just look at how airlines and cruise operators have developed their own booking processes. This advancement in technology has been a great opportunity for us to offer more services for more people.  
How can major companies best maintain the kind of agility required in a fast-evolving technological environment?
We look to maintain agility by relying on two key aspects that are central to our corporate culture. The first is that while we are a large multinational firm, we are always looking to operate our business in the most efficient way possible. We look to maximise productivity by removing any actions from our processes that have no added value to our end customer. This is part of our lean way of working. 
A strong managerial and team-based culture is what truly drives innovation – we facilitate this by having teams with a strong managerial presence for each of our core business lines. Furthermore, our managers go through a training programme that is based around four key behaviours: caring, availability, reliability, and being easy to work with. We believe that it’s important that we are ready both culturally and technologically as an organisation to achieve the agility necessary in today’s fast-paced environment.      
Your website has published guidance on issues like phishing, and how customers can avoid falling victim to scams. Do you think that companies such as yours have a social responsibility – beyond their responsibilities as an insurer or assistance provider – to educate the public on such problems?
We created our recent Cyber Barometer for many of the same reasons we created our Holiday Barometer, to explore consumer behaviour and share those findings with the public. We’ve been doing this for some time; our Holiday Barometer with IPSOS was created almost two decades ago, which we hope inspires consumers to visit new destinations and consider all that travelling has to offer. We launched the Cyber Barometer as our cyber protection platform has been an increased focus for us, and we hope that the findings get consumers thinking a little more proactively about safety when they’re browsing online and provide them with additional steps they can take to protect their digital identities. 
As another example, Europ Assistance’s Senior Care business exemplifies our support for our local communities that need to find solutions to care for elderly members of the community. We are striving to improve access to affordable, quality care solutions that will allow seniors to live long-term and self-determined lives at home.   
What would you say are the key elements involved in maintaining the kind of complex network of partners and providers that a major assistance company needs in order to operate?
These relationships can be very complex, but it often simply starts out by finding an organisation that matches our culture, especially when it comes to our core values. Additionally, we have core competency as both a recognised brand and a provider of white labelled services, so we understand the needs from both the provider and network manager side. We also do regular audits and adjustments of our global network to ensure we are providing our customers with an exceptional level of service. 
While our key values are a major factor in what truly sets Europ Assistance apart when it comes to choosing our partners and working as a provider, there is also the tremendously important aspect of having the right team members in place. The team must be a mix of those who can see the larger global picture and those who are working on the ground locally that have in-depth knowledge from the field. This synthesis of talent allows us to cover all the complex needs and intelligence that our partners and providers require – which leads to long-lasting relationships.   
In what ways have the global assistance landscape changed over the course of your career?
The biggest change is the continued blending of the assistance and insurance industries; while some companies are more integrated than others, it’s clear to see that insurance can leverage many of the same core concepts that assistance is based on, to help drive customer loyalty. 
Assistance as an industry continues to evolve rapidly. Where our business was once focused on assistance when it came to automotive, travel, and home emergencies, we’ve now expanded our scope to assist with the problems of today, including senior care, identity theft and cyber protection, and healthcare. While the issues may change, assistance at its core will always be about managing networks that assist customers in relieving stress, especially during the most difficult of times. 
Can you describe a typical day as CEO of Europ Assistance?
The nature of the assistance business means that there’s really no such thing as a typical day for me as CEO. That said, I believe that to be a great leader it’s important to be close to my teams if we are going to work together to grow our organisational culture. For example, at the Europ Assistance offices all the teams are on one floor and we don’t have fixed desks – in fact, I don’t even have an office of my own! Instead, we utilise a shared desk system to foster and maintain a connection between teams. This also allows me to easily meet with the heads of all our teams, including finance, operations, sales, marketing, legal, HR and so on – which creates a very open and collaborative environment. 
Of course, our offices’ proximity to the Generali offices also ensures that we’re in regular contact with our parent group. Most importantly, we’ve established a bi-weekly meeting amongst our GMC, or a group of top managers from our major regions, where we discuss some of the key topics currently impacting our business.
So, if there is one common thread in terms of a typical day for me as CEO, it's constant communication with our incredible teams.  
Which aspects of your role do you enjoy the most, and which are the most challenging?
The fact that we are a global organisation is one of the most challenging aspects of my role, but in many ways it’s also the aspect that I enjoy the most. Being CEO of a large multinational group like Europ Assistance means I need to not only consider all our entities across the globe but, even more importantly, our worldwide customer base. This requires us to think globally in order to cover a wide array of sectors. In many ways, it’s much like my first job of being an actuary in that I’m uniquely positioned to be aware and make sense of a constantly changing world.
What are your proudest achievements, both personally and professionally?
My biggest professional achievement has been turning Europ Assistance into a truly global group during my tenure as CEO. When I joined back in 2014, Europ Assistance was what I would consider a federation but now, with our unified corporate culture that we developed around our managers and teams, we are operating as one fluid organisation. 
My biggest personal achievement is of course my loving family. I’m also very proud of the physical (and mental) achievement of completing a triathlon. ■


Assistance as an industry continues to evolve rapidly
Feature category: 

Making the leap

Assistance & Repatriation Review | April 2019
Carlos Hernandez
Operations Manager
Tangiers International

ITIJ caught up with Carlos Hernandez, Operations Manager at Tangiers International, to talk about his role, digital claims, and a particularly challenging assistance case

How did you first get started in the assistance industry, and how did your career progress to your current role?
It was purely by chance! I was given the opportunity to use my language skills when working for a health check screening company based in Wakefield, UK, in the early 2000s and that was my first contact with the travel insurance world. From there, I got a taste for helping people and my interest in assistance grew. Later that decade, I moved into repatriation and claims handling where I gained a deep understanding of complex medical evacuation protocols, providers, hospital liaison and expectation management and team management.
Finally, the chance arrived to make the leap to Operations Manager with Tangiers International early in 2017.   
Can you talk us through a typical day in your role as Operations Manager?
This is a challenging role! Apart from checking that all systems are working and all members of the team are ready for work, there are other things such as: making sure that payments to providers are made in a timely manner; delegating tasks; contacting providers and updating existing contracts; checking that all members of my team are up to date with training, protocols, and so forth; creating reports, organising and attending meetings, supervising cases and claims; contacting underwriters and brokers; checking, updating and creating new schemes; liaising and informing accounts when we need to invoice; guiding the Operations Team; reporting to the General Manager; solving problems; updating rosters … and anything else that may come my way. 
What, in your opinion, are the key elements of facilitating a smooth and co-operative relationship between an insurance company and an assistance company? 
Clear and precise communication is vital – knowing who is doing what and how to contact the correct person if necessary. A good explanation of benefits and exclusions on the policies, avoiding ambiguity. And quick responses in case authorisation are needed for high-cost cases.
How has the global landscape for assistance changed over the past decade, in your view? 
People are travelling to more challenging places, where there might be problems with communication, political unrest or lack of services. Insurance companies have had to adapt to this changing world and have opted to offer assistance in other ways such as telephone apps for on-the-spot information about medical facilities in an area, information on safety or by having on-the-ground agents that can actually call or visit the insured directly and give local advice in the local language.
Has introducing your Tangiers Travel App made a noticeable difference to your relationship with your clients?
It has changed in the way that it is easy for them to submit claims without the need to use emails or even call us! They can attach all the necessary documents and get an instant reply with their reference number, and a member of the team can message them asking for further information or call them if required. They can also use the app to get a list of hospitals and medical facilities in the area where they are, should they need them. Obviously, we are always at the end of the phone 24/7 if our clients prefer to speak to one of our operators.
Can you give us an example of a recent case that proved particularly challenging?
We had to transfer one of our clients from Afghanistan to India for an operation. There were issues with the Indian Embassy as it would not issue a visa to this particular person unless there was an invitation letter from the receiving hospital in India. To expedite things, we contacted the hospital directly and also our Tangiers International agents in India and Afghanistan. They sent the letter, but still the visa was declined as the claimant’s companion was not considered a close family member (they were a cousin). This was changed, so that the new companion was the patient’s father. Still, the visa was declined as the patient had less than six months on his passport! Eventually, all was fixed with the help of our field agents on the ground and the claimant made it to India. He was operated on and discharged. Pakistani air space was closed on the day he was scheduled to travel back to Afghanistan, plus the airline lost his booking. Again, our agents had to intercede and accompanied the patient to the airport, where they managed to solve the problem with the ticket and helped the patient with wheelchair assistance, and so forth.
Finally, the claimant arrived back in Kabul, where one of our Tangiers International agents was waiting for him, although he decided to travel onwards with a family member who was also there.
Of course, all assistance cases are complex in their own way, but are there any hotspots around the world at the moment that pose a particular headache when providing assistance?
Yes, in particular war-torn countries, where it is difficult to have an agent and where the infrastructure has been decimated and where it is difficult to get permission to land in case of medevacs. Examples are Yemen, Libya and remote areas of South Sudan.
What are the most challenging aspects of your job?
Finding a solution for every problem or challenge while under pressure and in a timely manner.
What are your proudest achievements, both professionally and personally?
I was part of the team that designed and implemented a new system for repatriations. It was great to see other people being trained on something I created. As a person, my proudest achievement was helping a dear friend to come out of his depression following a serious health problem. He now lives a full and productive life.
If you could invite any three people – living or dead – to a dream dinner party, who would you choose and why?
My mother – she was the wisest and most caring person I know. My other half – just because I love him and he could just not be out. And my best friend – because she’s the best and keeps me in check!




Insurance companies have had to adapt to this changing world and have opted to offer assistance in other ways such as telephone apps for on-the-spot information about medical facilities in an area
Feature category: 

Communication, consolidation and care

Air Ambulance Review | March 2018
Mark Jones
Air Ambulance Worldwide
Mark Jones, Owner of Air Ambulance Worldwide, spoke to ITIJ about his time in the industry
You’ve been in the international air ambulance business since 2004; what are the main changes you’ve witnessed during this time?
I have witnessed many – but the main changes that I have seen are the improvements in communications. These have come in the form of cellular, satellite and internet quality and availability. This allows the clients, providers and medical teams on flights to be more effective and efficient. The quality of medical care and overall process is enhanced by these improvements.  Also, there have been improvements in aeromedicine and medical equipment. Another change is the recent consolidation of companies over the past three to five years.
Communication is a top priority in the travel and health insurance sector; how does AAW ensure that clear and sufficient medical advice is obtained from a treating hospital before you pick up a patient?
The first step in attempting to confirm a patient’s medical condition is to ensure that we have obtained the best possible pre-flight medical report. The quality of the report can vary based on factors such as location, language and in some cases the availability of the medical staff providing the report. Some countries or hospitals will only give doctor-to doctor reports, and we try to plan for this eventuality so as not to delay the flight. We have had cases where we required a translation service, but typically our staff handle the day-to-day cases. We obtain all current medical records from the sending facility, including CT scans, H&P and so on before we depart. Our standard protocol is to go to the treating facility to perform a bedside assessment of the patient. This confirms the information that we were provided and ensures that the patient’s medical condition has not evolved since the pre-flight assessment was obtained. Once it is confirmed the patient is fit to fly, we will then depart.
Your recent purchase of Aero National has increased your ability to serve US-based patients; is this acquisition the beginning of a global expansion plan?
The purchase of Aero National, although early in the integration, has proven to be a solid strategic move. Their location adds to our geographic footprint and increases the value proposition to our clients by providing a high-quality provider in an area where there is little service. When it comes to expansion, we are looking at strategic rather than global expansion. The location of Aero National lends itself to further expansion and to providing a comprehensive solution for our hospital, assistance and individual clients.
The value of accreditation is an ongoing debate in the air ambulance sector; what made you decide to obtain EURAMI accreditation, and why did you choose this organisation rather than another one? Do you find that insurers were more willing to work with an accredited air ambulance company?
I hold true to my belief that accreditation does add value to a company, the industry and the clients that we serve. We first applied for accreditation in 2009 because I could see the value that accreditation brought to a company. Not necessarily that it would help us obtain additional clients, although it did, but that by going through the ‘process of accreditation’ and having the organisation work with us, it would improve our company as a whole.  
We chose EURAMI for a few reasons; one was that we were dedicated to serving the worldwide demand for quality providers and EURAMI was the only worldwide accreditation organisation in 2009. The other credentialing organisations were domestic US only, although that has changed to a degree now. Also, I was familiar with the other organisations and we believed that we would get the greatest hands-on support from EURAMI. They were helpful in answering questions that are a normal part of our striving for continuous improvement. In regard to insurers working with accredited providers, that is why I had made the decision in 2009 to become EURAMI accredited, I could see that the industry was moving in that direction and so we committed the resources to obtaining accreditation.
You have Special Care accreditation from EURAMI – how much more difficult was this level of accreditation to achieve than an ordinary accreditation?
We are always working to improve our service and continually raise the bar of excellence for our teams. We were honoured to reach the level of recognition that we did during our last audit which was Long Range / Intercontinental Fixed Wing - Advanced Adult Critical Care. We were able to reach the advanced level due to the type of cases and the level of care that we can provide. If a company cannot provide a certain level of care, it will merely take time and dedication of resources to obtain the next level of care if they so desire. Everyone may not have the need to reach other levels, yet they can be a good provider.  
At the recent ITIC Global in Geneva, cases were discussed where air ambulances had taken off to collect a patient before landing permits were obtained, or where a guarantee of payment/coverage had yet to be issued. Have you experience in such missions, and how do you manage these risks?
In the scenario that you ask about (leaving without a landing permit) there are multiple risk factors that must be considered. Key considerations are the patients’ medical condition, current level of care and the experience we have with the country in question. Sometimes the risk is low because of the frequency and familiarity that you have with them. Others, such as Cuba, preclude departure without an issued permit. Like much of what we do, the decision is often based on the relationship we share with the client. Mutual trust goes a long way when weighing these factors.
What do you enjoy most about your role?
Every day, I look forward to walking into our corporate office and seeing each and every one of our employees. I know that over the next 24 hours we will help our clients, patients and their family members through a difficult time in their life. No one wakes up and says, ‘I think today I will need an air ambulance’, but when they do, we will be there to help them. That makes me feel good.
What do you view as the biggest challenge facing the air ambulance industry in the current economic climate?
I am sure that there are many challenges that will come to light over the next few years, but the aircraft upgrades are certainly looming large on the horizon for some. The ability to stay ahead of the curve regarding technology and regulatory requirements of 2020 aviation standards will present challenges for some of the smaller providers. Upgrades are both expensive and time consuming to install, and the process has the added disadvantage of grounding part of your fleet for the duration of the upgrade process. Like so much of our existence – planning becomes key. 
The ability to stay ahead of the curve regarding technology and regulatory requirements of 2020 aviation standards will present challenges for some of the smaller providers
Feature category: 

Taking stock

Issue 215 | December 2018
Richard Lonsdale
Head of Client Services
Generali Global Health

ITIJ caught up with Richard Lonsdale, Head of Client Services at Generali Global Health, to talk about the global health insurance landscape, 2018’s key developments and the challenges waiting in 2019

How did you first get started in the international health insurance industry, and how did you progress to your current position of Head of Client Services at Generali?

After completing my degree, I started work at AXA PPP healthcare as a personal advisor on the front line. I handled claims and membership queries from members or their brokers, which was a great introduction into health insurance.

After a couple of years, I was promoted to team manager, before making a switch to managing provider relationships as part of the network management team.  This was a terrific experience and ultimately led to a move into international provider management with the – then relatively new – AXA PPP International team.

I was selected to join a new venture with AXA Healthcare Management in Singapore, where we worked with local AXA entities to design, build and distribute international health products through their local distribution. My focus was to build the medical network in Asia to support the proposition, but I ended up doing all manner of relationship management and development. When that came to an end, I returned to the UK and felt the time was right for a new challenge. I had been with AXA for 17 years by then and was fortunate that Generali Global Health was looking to establish itself as an IPMI insurer – I felt that the role was perfect for me to build on the good experience I had garnered over the previous years with AXA PPP.


Can you describe a typical day in your role?

Well, every day is different! Being a relatively new division of the Group and with a steep growth trajectory means that there are opportunities to be involved in a wide variety of different aspects of the business, which certainly ensures life isn’t dull! 

I work with a great client services team who handle all our clients’ and brokers’ needs to a very high standard. I also handle relationships with some of our distribution partners, work to develop new markets, and am currently in Hong Kong for a few weeks to support the development of our proposition here in Asia.


Your job requires you to co-ordinate with a varied range of partners and service providers. What would you say are the key elements of maintaining strong working relationships within such a complex network?

Regular and good communication – especially face to face. There is sometimes a tendency to rely on e-mail and conference calls in our industry, but I think there is a danger that this can devalue and automatise relationships. You cannot beat face to face meetings for really establishing and building on relationships as well as accessing opportunities that would not be possible purely with remote communication.


How in your view has the global health insurance landscape changed over the course of your career?

On the positive side, the increase in competition can only be a good thing in terms of increasing choice for the customer, and as a result service has improved massively, especially in relation to greater access to centres of healthcare excellence and ease of claiming through digital developments such as online claims submission.

However, the industry has been maturing quickly, and part of this is a change in focus I’ve seen from chasing innovation to a more measured attitude to development of products and services for customers. I think, therefore, that there is scope for businesses such as ours to make a difference in terms of innovative product design and service delivery, as well as taking far more of a ‘whole health’ approach for our customers. Insurers have historically been payers of claims when treatment is required but this is very reactive. The focus should be on health maintenance, identifying health risks and proactively addressing them before it gets to the point where people develop conditions that require treatment. Insurers need to start to be far more proactive in this regard, especially with the significant increases in non-communicable diseases.


Congratulations to Generali Global Health on winning International Travel & Health Insurer of the Year at this year’s ITIJ Awards. What does this title mean to Generali and how do you plan to leverage the win going forward?

This is a terrific win and certainly an endorsement for all the hard work we have put in over the last three to four years. I think it really is a benchmark for us now – Generali Global Health is here for the long term and winning recognition from peers, clients and intermediaries needs to become something we continually strive to achieve to keep us fresh and vibrant in the industry. 


As the year draws to a close, what would you say have been the key developments / trends in the global health insurance industry in 2018?

The move from being purely a payer of claims to a wellness partner is how the industry must continue to develop and remain the focus of transformation.

For our part we have significantly expanded our whole health approach. We have increased our digital solutions such as our wellness app Bria, which tracks healthy behaviours and allows you to set health goals and targets and enter challenges. This interfaces with a number of wearables and intuitively provides information on challenges to reach your health objectives. We’ve also added a telehealth app, My Digital Doctor, which enables members to access a qualified GP in their language from anywhere in the world through their mobile.

We have built on this holistic approach by providing services like second medical opinion and genome testing for cancer treatment to ensure our members get the best health outcomes should they fall ill.

However, insurers must ensure that they are supporting healthy behaviours and providing a support framework that promotes health maintenance in a way that is easy to access and is engaging, as well as ensuring that, should the worst happen, access to care and optimum health outcomes can be achieved.

And looking ahead to 2019, what are some of the main challenges facing the industry?  

I think we all need to relook at our proposition – we can be guilty of deciding that we know what the customer wants before they have had a chance to tell us, and as a result provide an answer before we have really considered the question. 

We need to rediscover our appetite for risk in terms of new products and new markets that traditionally have fallen outside what most IPMI players consider to be ‘normal’. At the moment, we as insurers tend to deliver broadly similar propositions, and they have not moved quickly to establish the changing needs of people when it comes to international health insurance provision. If the industry is to be progressive there should be moves to enter new markets and engage with local experts, which will bring its own challenges – how willing will we be to be so flexible and humble?


What are the most challenging aspects of your job?

Keeping clients and partners satisfied, having to look into the detail and really understanding their needs and, once identified, creating solutions that create real value for them.


What are your proudest achievements, both professionally and personally?

Collecting the ITIJ Award for best insurer obviously! Apart from that, being part of something great at Generali Global Health; building a really good medical network with fast and effective access; meeting and working with really good people; being married to a wonderful wife with two great kids.


If you could do any other job in the world, what would it be and why?

Cavalry officer in the Blues and Royals. Elan, fun, excitement and leading from the front.


I think that there is scope for businesses such as ours to make a difference in terms of innovative product design and service delivery, as well as taking far more of a ‘whole health’ approach for our customers
Feature category: 

Traversing the landscape

ITIJ 214, November 2018
Jayson Westbury
Chief Executive
Australian Federation of Travel Agents

ITIJ spoke to Jayson Westbury, Chief Executive of the Australian Federation of Travel Agents (AFTA), about the landscape of travel insurance and travel agents in Australia, travel trends, and the importance of consumer awareness

What is your background in the travel industry?
I have been in the hotel, hospitality, tourism and travel industry my entire working life of 35 years. I have held operational positions in both large and small companies and have worked for the past 23 years in some form within the government relations environment of the industry via industry associations and representative forums. 
Where does travel insurance promotion fit into the overall agenda for AFTA?
AFTA is a strong supporter of the Department of Foreign Affairs and their Smartraveller initiative. In fact, AFTA works closely with the Department of Foreign Affairs and Trade (DFAT) to educate Australians about safer, smarter travelling.  
Travel insurance is an essential part of travel, as it is all about protecting the traveller against the unexpected. Additionally, AFTA is committed to supporting the Government’s important messaging to Australians that ‘if you can’t afford travel insurance, then you can’t afford to travel’. 
There are many convincing reasons to buy travel insurance. Your flight has been cancelled or delayed, your passport or wallet has been stolen, you need to cancel your trip due to illness, you have a medical emergency in a foreign country, the airline loses your bag, there’s a family emergency back home, there’s a hijacking or terrorist attack. Or even just peace of mind!
Travel insurance is a key piece of the conversation that takes place between a travel agent and a client when booking travel and there is a commitment to support travel insurers who support the travel agency community. 
How significant is sale of travel insurance to your members, not just in terms of revenue, but also in terms of their Duty of Care liabilities?
Insurance forms a part of the revenue mix for travel agents. It is not a key source, but a supplementary source. The ongoing challenge that travel agents face is online resellers of insurance products that are stripped down in order to look very cheap, but in fact do not serve the consumer or the industry well in the end, as in many cases the consumer ends up under insured or not informed correctly as to what exclusions, travel zones or other important aspects may apply to their trip. There is a duty of care by the travel agent and as such they remain best placed to ensure the correct insurance options are presented for the consumer to choose. 
Does AFTA support its members with regards to education and training around selling appropriate travel insurance to their customers? 
Due to the regulatory framework in which travel agents sell travel insurance, the process of education and training remains the responsibility of the insurance companies directly. AFTA supports as needed, but in most cases insurance companies do a good job at this with agents. 
What are some of the key issues that travel agents come up against when it comes to selling appropriate travel cover to customers?
Price is unfortunately the number one issue. This has not been something that the agents have created, it has been the online portals that have grown with the support of the insurance companies, we believe looking for volume over quality. 
Has the changing regulatory landscape in Australia affected the sale of travel insurance by travel agents over the years? What are the current legal requirements on travel agents when it comes to recommending travel insurance to customers?
The regulatory landscape for selling travel insurance has been very stable and it is well understood by the industry and insurance companies. Travel insurance is a financial product and such travel agents are not licensed to give advice in this regard. What they do is ensure that choice is provided to the consumer and that they identify the key factors that they should consider when deciding which insurance the consumer wishes to purchase. 
Would you like to see closer co-operation with Australian insurance associations – or other bodies – to ensure travel insurance sales are better supported in the travel industry?
Absolutely. There are currently several legal cases afoot in Australia in which insurance companies are placing the relationship at risk. It is bloody-minded and short-sighted. We remain concerned about these behaviours by some insurance companies. 
You recently gave a presentation at the International Travel & Health Insurance Conference (ITIC APAC) in Sydney about Australian travel trends. What key travel trends have you seen over the last few years related to Australian travellers?
First and foremost, an immense increase in the number of Australians travelling overseas. Australia is the eighth largest by number (not per capita) outbound market in the world and for a small country on a global measure we punch well above our weight. Fifty-six per cent of Australians hold a valid passport, this is the second highest penetration rate in the world. The Australian economy, living standards, annual leave entitlements, wealth in retirement and political settings provide for a robust travel industry and we hope that this will remain for many years to come. 
How does AFTA work with other industry bodies or governments (such as on the Smartraveller initiative) to promote safe travel practices?
AFTA has a strong working relationship with DFAT, in particular Smartraveller, in providing weekly notices of changes to the travel alert levels to our travel agent members to assist in communicating directly with their customers prior to travel. AFTA often communicates to our network strategic messaging from Smartraveller in regards to special alerts, passports, travel safety and consular services to help educate Aussie travellers before they depart overseas. 
Going forward, what are your plans for AFTA in 2019?
AFTA administers ATAS – AFTA's Travel Accreditation Scheme, a national scheme which endorses businesses based on meeting strict criteria and industry standards. AFTA recently conducted consumer research which demonstrates the growing importance of industry accreditation, for the consumer, due to the endorsement, trust and peace of mind that the Scheme offers consumers purchasing travel. 
The research revealed that 82 per cent of travellers will actively look for an accredited travel agent when booking travel, and 54 per cent of consumers want ATAS to be more strongly promoted to help them make informed purchase decisions.
In 2019, AFTA remains committed to elevating industry standards and ensuring that the 1,300 accredited travel agency locations around Australia continue to be compliant with Australian Consumer Law and the Scheme’s Code and Charter. Educating the consumer about industry accredited travel businesses is also of utmost importance. ■
Travel insurance is a key piece of the conversation that takes place between a travel agent and a client when booking travel
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Air Ambulance Review 2018 Profile

ITIJ 212, Air Ambulance Review, September 2018
Carlos Salinas
Jet Rescue
Carlos took time out of his busy schedule to answer a few questions about his background in the industry, and to highlight the many operational and medical challenges that come from operating in Latin America
How did you first get started in aeromedicine?
I was a paramedic working as the Operations Manager for a ground ambulance company in Guadalajara, Mexico. Richard Williams, who at the time was the owner of Air Evac International in San Diego, US, visited the company to market his services. Shortly thereafter, I started referring patients to Air Evac, and eventually got a job with Air Evac International.
How did your career progress to your current role as CEO of Jet Rescue?
Very early in my career I was placed in leadership roles. For example, at the age of 19, I was the Paramedic Lead Supervisor for former Mexican President Miguel De La Madrid’s paramedic team. Being exposed to very demanding positions that young, plus my desire to succeed financially, led me to own various companies, including Jet Rescue.
What are your main responsibilities as CEO? Can you talk us through a typical day in your role?
In the early days of Jet Rescue, I was mainly an operator. As the company has grown, I have been able to leave most of the operational side of the business to my ops team, although I still directly manage some key clients. Currently, I spend most of my time performing strategic and tactical planning to ensure that Jet Rescue continues to be a key player in the industry, as well as developing alliances and allocating the necessary resources to our staff so they always deliver an uncompromising level of care, meaning that they never have to apologise to one of our clients for not meeting – or exceeding – their expectations. I am also preparing the next generation of Jet Rescue executives so that they can be ready for leadership as I retire.
What are some of the biggest challenges you face when performing air ambulance missions in Latin America?
There are many operational and medial challenges when you operate in third-world countries. One of the main challenges we have to overcome is the lack of advanced medical care in most of the region (with the exception of large cities). This lack of availability of high-quality care, combined with the inaccurate information that we receive, means that most of the time our teams have to provide advanced medical interventions on site when they arrive to pick up a patient. The accreditation organisation EURAMI has defined our type of work as programmes that have a ‘delayed primary’ role, i.e. collecting the patient from the nearest landing strip or airport to the point of injury or illness in order to deliver the patient to a primary receiving hospital emergency department (or other acute facility).
Typically, these flights are from remote areas to isolated hospitals. The necessary skill set for our flight medics is therefore similar to that of a HEMS (helicopter emergency medical services) team. Other operational challenges include the fact that most airports in the region are not open 24 hours a day, as well as militarisation in countries such as Venezuela and Bolivia, which limits our access to airports.
What, in your opinion, are the essential aspects of maintaining positive and productive working relationships with your clients in the insurance and assistance sectors? 
To me, the most essential aspect of any relationship is honesty and transparency. Being honest and transparent with our clients builds trust, which is the single most important aspect of any relationship. Another essential aspect is reliability and performance. Jet Rescue is all about trust, reliability, availability and performance.
You also recently became CEO of security service provider Blackwater Global Protection. Have you been able to adapt your expertise as an air ambulance CEO to your new role?
Part of my previous experience has been in the field of law enforcement and military services, so putting all of these skills together has actually been very easy. One thing led to the other in this instance; some of our clients not only needed an air ambulance service out of our region, but they also needed someone on the ground assessing the whole case, giving accurate information, providing security detail, armoured vehicles and on-site intelligence. I see it as a complementary service, since we already had most of the logistics and assets in place. I am very entrepreneurial by nature, so I am always looking at parallel businesses that can complement each other and that no one else is able to provide with excellence.
Can you give an example of a recent operation that posed particular challenges for your organisation?
We recently transported an extremely ill patient out of Cuba. This patient was meant to fly – after the air ambulance leg from Cuba to Miami – on a commercial stretcher from Miami to Europe. Communication with the Cuban hospital and local assistance company, though, was almost impossible. The Cuban medical report stated that the patient was stable. Upon arrival in Cuba, however, our medical team found a patient whose condition was in fact extremely critical. We worked with the patient for almost eight hours to get her stable enough to fly to Miami. The patient was obviously not fit to fly on a commercial stretcher and remained in the ICU in Miami for several days. Eventually, we transported her by air ambulance from Miami to Europe.
What is your favourite aspect of your job?
Thinking! The fact that this is a very competitive and fast-changing industry poses a great challenge, not only to survive, but also to remain a key valued player. Bringing value to the clients require a lot of creative thinking and I love that. I schedule and spend at least three hours ‘thinking time’ every week.
Also, I love the fact that every single day is different: different challenges, different missions.
Which three people – living or dead – would you invite to a dream dinner party, and why?
Steven Jobs – his creativity, innovation and philosophy are all attributes that I admire very much. He thought differently.
Napoleon – he was able to win battles against superior forces with minimal losses and was beloved by his people, many of whom felt he was invulnerable and could never be defeated. At one time, he had an inferior force, and was fighting two great empires, and defeated them both. We are a small company winning battles against larger and more powerful competitors.
Tony Robins – he has not forgotten his humble roots and uses part of his money to help needy people around the world. Obviously as a life coach he is amazing! n
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21st century healthcare challenges

ITIJ 212, September 2018
Phil Austin

ITIJ spoke to Phil Austin, CEO – Europe at Cigna in the UK, about the challenges of 21st century healthcare provision, the impact of technology and the importance of prevention over cure

How did you first get started in the international health insurance industry, and how did you progress to your current position of CEO – Europe at Cigna?
I started my career at Cigna back in 2002 as Partnership Director for Cigna International, and apart from a few years when I briefly left the business, I’ve been with the company ever since.
I have enjoyed working across a mix of international and European business lines, from being the European Sales and Marketing Director and the Head of the Global IPMI Business, to MD of UK HealthCare Benefits and General Manager of the Domestic Health and Travel Business.
As part of Cigna’s International Health Solutions leadership team, I oversee strategic market development to drive accelerated growth in Europe. We intend to grow the business and bring our expertise to a much wider European audience so it’s an exciting challenge at a time when global mobility and demand for health benefits are increasing. 

How has the global health insurance marketplace changed over the years you have been with Cigna?
The biggest change is the impact that technology has had. Of course, you’d struggle to find an industry that hasn’t been impacted by technology but the implications in healthcare are really quite fundamental. Technology has allowed us to move into a space where we are not just treating conditions but helping to catch them earlier or even prevent them developing in the first place. 
From a strictly business perspective, technology is the key to cost control in terms of helping to provide more accurate diagnoses, leading to fewer unnecessary procedures. It also enables earlier intervention to minimise the need for costly treatments in the first place. I read a report from McKinsey recently which predicted that clinical solutions and healthcare value services, such as medical cost and population health management solutions, are likely to grow rapidly due to concerns around cost. By using data to inform our decision making, we are starting to tame that medical cost trend. 
In your view, are health insurers keeping pace with new technology and effectively leveraging it to improve their proposition for customers?
Insurance in all its forms is a very traditional industry but the pace of technological change over the last five years or so has been really exciting to watch and be a part of. I would say that some of the healthcare providers out there have struggled to keep pace with this change – many have been unable to develop the capabilities, acquire the talent, and transform their organisations at the pace required.   
At Cigna, we’ve invested heavily in our digital capabilities such as our online member portal and also in new integrated digital health and wellbeing solutions, using app technology to allow customers fast access to telehealth medical consultations and lifestyle coaching tools to support preventative care and behavioural change. 
It meshes perfectly with the time-poor tech-enabled lifestyles of the 21st century workforce and is a great demonstration of the power of technology to help us meet client needs in fresh new ways.
How can companies like yourselves help employers to manage costs without impacting on customer care?
We want people to be healthy and when they are not, we want to get them back to full fitness as soon as possible. But we don’t want to do that at any cost or compromise the experience that our customers have during and after treatment.
To that end, we are collaborating with primary care groups and multi-speciality groups to provide a range of reporting and analytic mechanisms to better measure the approaches healthcare teams take in caring for patients and improving the experience and outcomes for patients. Fundamentally, it’s about improving our customers’ health whilst minimising the length of time and waste that often occurs in delivering healthcare. 
What do you see as the biggest challenges facing international health insurance providers? And is the industry ready to tackle them?
The twin linked challenges of medical inflation on one side and cost containment on the other continue to be major issues for the industry. But although rising medical costs are obviously a big concern, they really are a catalyst for change. It forces the industry to look at new ways of doing things and of improving the services we provide. 
The need to maintain affordability of cover, for example, is one of the main drivers behind the focus on wellbeing – keeping people healthier for longer is a win-win, not only in terms of managing medical costs but also in better quality of life and higher productivity. Prevention is better than cure, so what looks like a negative factor when viewed in one light can actually yield positive outcomes if we approach it in the right way.
It’s also important that insurers respond to the changing nature of the workforce and develop the agility and flexibility required to meet the needs of all types of workers – from self-employed and remote workers to the globally mobile and those working in challenging environments, for example.
What is the biggest ‘health’ challenge facing business today?
Our recent global survey revealed that unmanageable stress is one of the top wellbeing issues facing employers today. But the good news is that employers are beginning to recognise the cost of poor mental health at work and the impact this can have on their employees and business, and are starting to do something about it.  
In fact, we were one of the first healthcare companies to introduce self-referral for any mental health or emotional wellbeing concern with employees not needing to talk to a GP or their employer first. Early intervention is proven to enhance and speed up recovery, getting people back to work faster and with less risk of relapse. We offer ‘Living Life to the Full’, a digital CBT-based life skills tool to all our members. These courses can effectively support people with managing everyday low mood or stress as well as helping people to cope better if they’re living with a health condition. 
We also recognise the intrinsic link between mental health and physical health and all members receiving psychotherapy treatment are offered free gym membership to aid recovery.
In addition, another challenge facing employers globally is helping their employees to manage chronic and complex conditions such as hypertension, diabetes and so on – conditions that are known to be increasing in prevalence in our population as it ages. Again, insurers like ourselves are well placed to provide support to employers.
Are these ‘health’ challenges the same for companies with employees working abroad in different locations around the world? Absolutely, international exposure is often a significant draw to working overseas. Our own research shows that globally mobile individuals often experience anxieties related to macro-economic factors. They are particularly worried about the medical care available and the financial consequences of falling ill. They face additional challenges due to a higher level of insecurity and pressure from working outside their home country. And they are concerned about illness. Cancer and the fear of accidents are the main worries, followed by mental illness, including depression.
We put as much emphasis on pre-assignment work with our clients as well as supporting their employees when they are on the assignment, and we advise clients that it is critical to ensure that employees returning home from an international assignment continue to have that support while back in their home location – when they may experience difficulties settling back in.  
What are the most challenging aspects of your job?
Quite simply put, ‘regulation’. Regulation continues to change at pace around the world. It is vital as an organisation that we continue to keep abreast of all regulatory changes, and the impact and advice that we need to give to our customers and members. 
What are your proudest achievements, both professionally and personally?
Professionally, building and developing Cigna’s Global IPMI Business, and more recently building a new Cigna European organisation. Personally, my four children – they continue to remind me what is important in life and give me a great balance between work and family life.
If you could do any other job in the world, what would it be and why?
Bearing in mind how much I travel for work, I could definitely have been a pilot for BA! ■
We want people to be healthy and when they are not, we want to get them back to full fitness as soon as possible
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