Europe boasts some of the world’s best healthcare systems, with many countries offering affordable public healthcare, universal access and robust private options. In addition, the availability of advanced technology and an emphasis on prevention mean that European healthcare ranks highly on the global stage. For example, in Switzerland, universal coverage is mandatory for all residents, while in Denmark, 11% of the country’s GDP is poured into health. However, healthcare systems are under pressure and costs are rising. McKinsey analysed data from Eurostat and the Organisation for Economic Co-operation and Development (OECD) and found an increase of 3.4% between 2015 and 2019. In turn, costs are rising for health insurers in Europe; according to IMARC Group, the value of the European health insurance market was US$493.5 billion in 2024 and it is estimated to reach $752.6 billion by 2033. 

Oversaturation of healthcare services is prompting some to seek private health insurance and, in order to draw in customers, health insurers must innovate and customise. “We are seeing the development of private systems in the UK, Switzerland and Spain, which attract expatriates with faster access times than the public system, but at prices that are not always reasonable,” commented Isabelle Moins, CEO of APRIL International. 

Navigating different authorisation, reimbursement and tax structures can be challenging. That’s where IPMI providers play a crucial role

Cross-border care is growing in popularity and international private medical insurance (IPMI) is playing a greater role in ensuring the accessibility of high-quality healthcare across borders. 

“For many expats, cross-border treatment is a necessity, not a luxury,” stated Jeroen Van de Velde, CTO of Foyer Global Health. “They may live in a country with long waiting lists or limited specialist care, making it preferable to seek treatment elsewhere. However, navigating different authorisation, reimbursement and tax structures can be challenging. That’s where IPMI providers play a crucial role, offering direct billing, case management and provider networks that make cross-border care seamless.”

Meeting expectations

For insurers specialising in global healthcare solutions for expatriates, international workers and those who are globally mobile, IPMI policies that are cost-effective and respond to evolving needs are key. ITIJ asked Van de Velde about changing customer expectations. “We’re seeing a clear shift in what expats expect from their health insurance. The old, one-size-fits-all approach doesn’t work any more. People want flexibility, digital solutions and a focus on prevention, not just treatment,” he reported. 

Van de Velde said that a modular approach can be difficult to understand and, alternatively, cleverly combined multi-tiered plans can cover needs. “Expats might start with a leaner plan in early career years, focusing on core benefits, and then move to a richer coverage level when they settle down or start a family,” he explained. “Customisable deductibles allow further flexibility, making coverage both affordable and adaptable to different life stages.”

Moins noted that for expats deployed in Europe, benefits are evolving to better address their needs and improve their overall healthcare experience. “We are developing solutions capable of complementing local European schemes and are committed to helping our policyholders understand how local public and private healthcare systems work in their own language. We are also developing agreements with social security funds to facilitate the procedures for expatriates, such as CFE in France and SSOM in Belgium. In Switzerland, we have developed solutions to meet local requirements, so that international students who come to study in this country can benefit from appropriate insurance that complies with the requirements of the LAMal (mandatory health insurance).” Key customised benefits offered by APRIL International are enhanced mental health services for expats in the European Union (EU) and the expansion of cashless services with the Easy Pay Card.

A focus on wellness

Indeed, wellness and mental health are a key focus for many providers. “We offer wider coverage to improve accessibility, such as full refunds for cancer screening and full refunds for in-patient psychiatry and psychotherapy,” said Catherine Farrell, Head of Proposition Management, Health at Allianz Partners. “We have also increased the availability of our outpatient psychiatry and psychotherapy benefits on some of our individual and family plans and reduced the waiting period that applies. We have significantly increased the limits on our top-tier outpatient plan and expanded the coverage to include proactive health and wellbeing checks on our mid-tier outpatient plan.” 

Van de Velde agreed that there is growing emphasis on mental health and prevention strategies. “The industry is seeing a shift toward wellbeing programmes, mental health support and employee assistance programmes (EAPs) for corporate clients, helping to prevent illnesses before they become high-cost claims,” he highlighted.

Another area of focus is on ensuring that digital offerings are up to scratch. Farrell remarked that there has been growing demand for digital health solutions and telemedicine over the past year. This is a trend that Van de Velde also highlighted. “Digital transformation is changing the way expats access and experience healthcare. Telemedicine, digital health tools and preventative care are now seen as essentials rather than perks,” he said. “Artificial intelligence (AI) powered underwriting and claims processing improve efficiency, reducing fraud and ensuring more accurate risk assessments. Wearables and remote health monitoring are gaining traction, offering real-time health tracking and preventive care insights. In addition, fully digital insurance platforms are emerging, designed for digital nomads and highly mobile expats, offering seamless policy management and claims processing via apps.” 

People want flexibility, digital solutions and a focus on prevention, not just treatment

Moins agreed that technology is enabling fraud detection strategies to become increasingly effective: “With the growing complexity of healthcare systems and cross-border care, fraud detection technologies are becoming increasingly important. Innovations in data analytics and AI enable insurers to identify and prevent fraudulent claims more effectively. These tools ensure the sustainability of healthcare plans while maintaining affordability and trust within the IPMI sector.” 

Moins also highlighted the convenience and efficiency offered by direct payment technologies. “These are transforming the way policyholders manage their healthcare expenses. For example, APRIL International’s Easy Pay Card allows insured individuals to directly pay healthcare providers for expensive treatments, eliminating the need for upfront payments and lengthy reimbursement processes. This not only enhances convenience for expats but also streamlines the overall claims process, making it faster and more transparent.”
 

Striking a balance

Cost containment is an essential aspect of IPMI and it is a balancing act to contain costs while also meeting customer needs and expectations. “We have to ensure financial sustainability while delivering real value to expats who rely on our coverage,” Van de Velde said. “The key is smart healthcare access, prevention and fraud control.” 

ITIJ asked Farrell about the strategies utilised by Allianz Partners. “We always seek to negotiate competitive rates with the medical providers in our network, either directly or through our network of third-party partners. We encourage our members to use our suggested medical providers for the direct settlement of medical costs,” she stated. “Our cost control mechanisms include the development and negotiation of our regional medical networks for direct settlements; implementing fraud detection measures; and regular reviews by our medical services and claims teams of treatment paths and tariffs to eliminate excessive or unnecessary charges. We provide an extensive list of options to our customers to reduce and improve the cover provided, including cost-sharing (co-payments/deductibles), where the employee contributes to the cost of the care delivered; providing cost-appropriate alternative providers; and negotiation for additional discounts for our customers on a case-by-case basis.”

Van de Velde affirmed that fraud plays a key role in cost containment. “AI-driven fraud detection helps identify overbilling, unnecessary treatments, and other abusive practices, keeping costs in check while protecting the integrity of the system,” he stated. 

The industry is seeing a shift toward wellbeing programmes, mental health support and employee assistance programmes

Cross-border care

Cross-border care is an important feature of IPMI, allowing policyholders to access high-quality care in multiple countries. “The majority of IPMI plans offer, at a minimum, a regional area of cover, if not full worldwide cover, allowing the member to seek treatment in other countries,” said Farrell. “Where the necessary treatment is not available locally, we also cover the associated travel costs. Most European populations are set up well to handle good levels of local care delivery (for example the UK, France, Germany, Spain, Italy, Austria), so travel for treatment is unlikely in these countries. However, there is often a preference by expats to have more serious treatments and surgeries back in their home country.”

There are unique challenges associated with facilitating cross-border care, though, including complex regulatory and logistical challenges. “Cross-border healthcare is becoming increasingly relevant in Europe, as patients act as informed consumers, choosing treatment options beyond national borders,” said Van de Velde. “This is driven by long waiting times, specialist availability, and personal preferences. While legal frameworks like the EU Cross-Border Healthcare Directive exist, navigating access, reimbursement, quality assurance, and regulatory differences remains complex.”

Even when cross-border care is allowed, patients often struggle with pre-authorisation and reimbursement delays due to differences in national healthcare policies

Moins said that APRIL International addresses these through a coordinated approach. “Key efforts include preparing transfers between healthcare facilities. We ensure that the transition from one medical institution to another is smooth and well organised, securing a place in the destination facility. Our teams work diligently to confirm availability at the receiving medical facility to avoid disruptions in care, verifying the availability of treatment in the new country. If specific treatments are not accessible in the destination country, we assist policyholders in travelling with their prescribed medications. This includes managing customs requirements, ensuring proper storage conditions for medications, and addressing other logistical considerations. Our comprehensive coordination ensures that patients receive uninterrupted, high-quality care regardless of their location, while also navigating the complex regulatory and logistical challenges that often accompany cross-border healthcare.”

An evolving landscape

Van de Velde said that when it comes to regulatory compliance, some EU countries require IPMI companies to obtain specific licences, creating administrative burdens. He outlined that additional hurdles are access and reimbursement. “Even when cross-border care is allowed, patients often struggle with pre-authorisation and reimbursement delays due to differences in national healthcare policies. IPMI insurers mitigate this by offering cashless treatment solutions and clear guidance on reimbursement processes, ensuring members know where and how to seek care. 

“A further challenge is continuity of care, particularly for chronic conditions. Medical records don’t always transfer seamlessly between countries, leading to fragmented treatment plans. We tackle this by offering case management services, coordinating care between international providers, and leveraging digital health solutions to maintain accessible, secure medical histories.”

IPMI providers are critical in assisting expats with access to seamless and high-quality care and ensuring the claims process is as efficient as possible. By expanding mental health and wellness coverage, leveraging AI and telemedicine, and placing emphasis on prevention and customisation, providers are meeting demand and helping expats to access the care they need, when they need it, at a price that is reasonable. 

“The IPMI landscape in Europe is evolving rapidly, shaped by regulatory changes, digital healthcare trends, and shifting expat expectations,” said Van de Velde. “As insurers, we must strike the right balance between cost containment and service quality, leveraging telemedicine, digital health solutions and fraud prevention while ensuring seamless cross-border access. Expats today expect greater flexibility, preventive care and well-integrated digital services – and insurers that adapt to these needs will be the ones that succeed.”