International private medical insurance (IPMI) is a complicated industry at the best of times. No matter how much work goes into streamlining its processes, these products and services are fundamentally not simple to deliver; and even for customers working in traditionally safe, prosperous regions, all manner of variables must still be taken into account.

These variables multiply exponentially with customers living and working in more remote areas. There can be political and cultural barriers to overcome, technological deficiencies, a lack of essential infrastructure and/or personnel – and, of course, fundamental geographical complexities.

ITIJ spoke to four IPMI companies providing medical insurance to policyholders in challenging areas including – but by no means limited to – Antarctica, Bangladesh, Mongolia, Nepal and Somalia, to find out how they go about tackling problems that, as APRIL International’s Managing Director Joe Thomas put it, are “both varying and constantly changing”.

The first and most obvious problem one runs up against in a remote area is the fact that it is, by definition, remote. Roads may be poor quality or sometimes non-existent, and transport options will often be limited even if there are navigable routes. “[This can] make it difficult to reach these areas promptly,” said AP Companies’ Key Account Manager Eugenia Kononova, “leading to delayed or inadequate medical attention if not managed meticulously, [while] the absence of well-equipped hospitals, clinics, and specialised professionals makes providing comprehensive care and timely interventions challenging.”

All the respondents to this feature pointed to shortcomings in local medical facilities as a major and persistent problem – and even if a region does have accessible hospitals or clinics, there is no guarantee that they are of the standard required to treat serious conditions.

“Remote regions with limited population density, where mineral exploration or remote oil and gas operations might take place, for example, often face significant challenges in healthcare provision,” Thomas pointed out. “[And] the scarcity of quality healthcare facilities [makes] access to medical services difficult for both residents and transient workers.”

As a result, should an employee suffer a serious mishap while on assignment in such a region, they may need to be taken elsewhere. “The nearest care provider [might] be hundreds or even thousands of miles away,” said a spokesperson for Cigna – and this can dramatically affect the chance of a positive outcome, and increase the need for effective crisis management on the ground.

Additionally, apart from medical and transport facilities, other infrastructure can be severely lacking in these regions. “The absence of reliable communication infrastructure hampers effective telemedicine initiatives,” said Kononova, “complicating remote diagnosis and treatment.”

And as Cigna’s spokesperson pointed out, as well as a lack of basic necessities like clean water, food, roads and electricity, limited awareness can also be problematic. “Employee engagement and utilisation is a key challenge,” they said, “particularly for employees who may be in more isolated locations. It’s therefore important for the employer and the IPMI provider to regularly remind employees of the availability of their preventative benefits like routine exams and cancer screenings, and to use these when back home or in a suitable location.” 

That’s a lot of potential hurdles to overcome – and they’re just the tip of the iceberg.

It’s not always the case, but broadly speaking, the more isolated a region, the more likely corruption and political unrest are to flourish. A power vacuum caused by weak or absent government and ineffective law enforcement can make for a highly volatile environment, which exacerbates existing problems like poor-quality infrastructure and makes it difficult to retain skilled personnel, who may fear for their safety.

Economic instability, perhaps caused by sanctions or other externally imposed financial restrictions, along with underdeveloped regulatory and banking systems, increase the prevalence of fraudulent practices. And if an area is largely cash only, the simple act of making a payment suddenly becomes a much dicier proposition: even if the insured’s coverage doesn’t require them to pay upfront, unscrupulous actors may not take no for an answer.

Unfortunately, against such a backdrop, violence also becomes increasingly likely.

“One important group which uses our policies is journalists reporting on geopolitical events,” said Thomas. “[We offer] short-term plans for their assignments, which may often be in remote areas of Africa, the Middle East, and Asia. We understand the importance of providing not just medical coverage but also non-medical evacuation services for emergencies and high-risk situations, ensuring the safety and wellbeing of our policyholders wherever they may be.”

So with the scene set, what sort of coverage options do customers in these regions require, and how do insurers go about providing them?

More IPMI customers than ever expect tailored, personalised policies to suit their specific needs – but for employees living in remote and dangerous parts of the globe, tailoring is less a preference, and more a necessity. A journalist in a war zone will have very different requirements from a teacher working in a remote village in the Democratic Republic of the Congo – and both will have radically different needs from a stockbroker living in London.

“There isn’t a ‘one-size-fits-all’ approach,” said Cigna’s spokesperson, “and healthcare providers should offer a full solution – one that supports individuals’ personal and professional lives.”

Indeed, ‘comprehensive’ is a watchword for these sorts of policies, according to the providers ITIJ spoke to. All medical eventualities should be catered for where possible, with cover for hospitalisation, surgery, vaccinations, essential medications and consultations included.

Additionally, as previously mentioned, even if healthcare can be provided in these areas, paying for it can be problematic, so this must also be taken into account.

“Many providers require cash payments at time of service,” commented a spokesperson for Aetna International, “so without proper healthcare insurance, people can be left paying for high-cost care, out of pocket. [We] offer global policies with 100% coverage, [which] means our members don’t have to pay upfront at time of service.”

Of course, policyholders want peace of mind in the event of an emergency – whether that’s knowing appropriate medical treatment will be made available to them when they need it, or that repatriation will be provided should a worst-case scenario arise. However, it’s also desirable when possible to pre-empt such emergencies through preventative measures. These could take the form of regular consultations with doctors, digital wellbeing services such as virtual therapists, or online resources that keep policyholders informed and up to date about potential risks, such as disease outbreaks and terrorist attacks.

“Access to digital wellness services can help prevent and manage employee mental health and wellbeing through access to virtual coaches and personalised advice, wherever they are in the world,” said Cigna’s spokesperson. “We have invested heavily in our digital capabilities and app technology, which has allowed us to move into a space where we are not just treating conditions but helping to catch them early and, ultimately, prevent them.”

There are many other features that could prove crucial for policyholders living and working off the beaten track. Dedicated helplines – available 24/7, and with plenty of different language options – can provide essential advice and help customers to manage a developing situation and coordinate with medical personnel. Special security considerations may be required, with non-medical evacuation an option in the event that a chaotic political situation heats up. The providers ITIJ spoke to also unanimously pointed to mental health coverage as a must-have, whether to help deal with the fallout from an emergency, or simply to guide an employee who is having trouble dealing with the isolation and uncertainty of their assignment.

“Navigating international assignments requires a complex upheaval and re-rooting process,” said Cigna’s spokesperson, “and it’s important we ensure that mental health is treated just as importantly as physical health when working abroad.”

All of this needs to be planned for – but there’s a famous saying about best-laid plans…

With myriad potential requirements for policyholders come myriad potential problems. Aetna’s spokesperson pointed to cultural and language barriers, time differences and lack of effective networks as some of the most immediate knots to unpick, all of which require constant close cooperation with staff on the ground, well-integrated digital solutions, and clear communication at every stage.

Cigna’s spokesperson also homed in on a lack of accessibility as something to be tackled: “According to our latest research, 36% of the European population is unable to access [digital] healthcare platforms due to poor internet or phone signal. By ensuring virtual care services are also available via telephone, we can help overcome this barrier.”

Kononova, meanwhile, listed innovative solutions such as remote medical units as methods for overcoming logistical hurdles, as well as leveraging strategic partnerships for efficient transportation of medical equipment and medications to remote locations.

Above all, providers need to think on their feet, and stay engaged with situations that can be complex, volatile and liable to shift at a moment’s notice.

“One significant hurdle is the need to maintain up-to-date local knowledge and expertise to ensure the best possible medical support service,” said Thomas. “This includes understanding the unique healthcare infrastructure – both its strengths and weaknesses – and the medical challenges specific to each region. Finding the right partners with the right expertise in delivering services such as remote medical consultations in multiple languages is also essential.”

There is no easy route to providing the services that IPMI customers need as they navigate assignments in the toughest regions of the world. Technological innovation must go hand-in-hand with careful logistical planning, precise communication and good old-fashioned boots-on-the-ground experience – and that’s just to handle the known problems. There are always plenty of unforeseen issues lurking in the shadows too.

But so long as these employees continue to put their health on the line doing important work under the most difficult circumstances, hopefully they can rest a little easier knowing that their insurers are keeping abreast of these challenges.