ITIC Global 2025 | International global mobility – trends, challenges, and opportunities in the expat health insurance market

The ITIJ team are reporting from ITIC Global in Venice this week (2–6 November 2025), sharing the discussions that take place at the conference. Read all reports

Andy Edwards, President – International, Global Excel Management

Edwards started his presentation by stating that the international private medical insurance (IPMI) market remained attractive to insurers, estimated to be currently worth US$18 billion, pointing out that there were still good opportunities for profitable growth, with the caveat that this needed to be managed sensibly.

Edwards proceeded to outline some of the trends evidenced by data from McGrigor Group, which showed that there was strong growth projected to continue through to 2029 at approximately 8% per year.

Acknowledging that expectations had shifted, Edwards pointed out that previously international assignments were a vital part of how organisations grew, shared experience and built resilience. He said that the changes now were grouped into four main categories.

Firstly, the market had altered post-Covid-19 in that mobility is rebounding, but in complex ways; long-term assignments are giving way to shorter and agile placements, with more digital nomadism; there is greater complexity from more localisation, compliance and regulation; and there is an increased need and demand for wellbeing and mental health services.

Secondly, employers are demanding more: global ways of working are becoming more important; the cost of assignments has risen significantly, by 60%, including housing, which has increased by 44%, adding pressure on employers, who need to justify this cost and prove that it is still delivering value; and there is a desire for consistent care.

Thirdly, there are challenges associated with medical inflation, as costs continue to rise above general inflation, markets vary, and there is a need to align all the incentives of payers, providers, and patients.

Lastly, Edwards said that expatriate hotspots were moving, stating that there was increased demand in Asia, the Middle East, and Africa; on top of this, creating a demand for robust local servicing and scalable global models, he said that emerging markets were no longer just destinations for expatriates.

Edwards said to facilitate a win-win outcome, there was an increased need for assistance and clinical governance to achieve better outcomes, and value-based care needed to start by steering members/patients to the right care (not necessarily the most expensive care), and by making sensible use of technology – matching the right level of care to need. He warned that the overuse of technology was a risk, and IPMI customers who were spending a lot of money for their service would often feel a right to have some level of human interaction.

Moderator Mandy Langfield asked where the current locations were for medical inflation, and Edwards said that an example of this was Hong Kong, where the local general practitioners had rapidly increased the level of small dermatological surgeries such as mole removal.

Victoria Clark, Commercial Growth Lead for Global Health Benefits, Cigna Healthcare

Clark began by outlining the three main areas that she was going to focus on:

• The global landscape, including medical inflation and changing dynamics
• Trends in what customers and clients are demanding
• What is driving these changes, and how as an insurer we are responding to these changing needs.

Highlighting the global landscape, Clark said that it was a very dynamic and uncertain external environment, where the political climate was volatile with changing tariffs and complicated regulations, the rise of artificial intelligence (AI) was bringing exciting opportunities but also many quality and control issues along with it, and the overwhelming pressure on public healthcare systems was limiting timely access to healthcare. In light of these problems, Clark added that organisations needed to focus on a mission: “To support the health and vitality of those we serve.”

There was a decline in longer-term ‘traditional’ expatriate assignments, said Clark, whereby working from home or hybrid working had helped employers “attract and engage international talent”. This has the effect that some countries are introducing visas tailored to improving smooth relocation or cross-border roles for remote workers. Clark also said that some companies were increasingly customising mobility packages to take into account personal employee and family member needs, and were finding that this helped attract talent and retain their employees.

One challenge that hadn’t gone away, explained Clark, was high global medical inflation, with double-digit increases in claims by 20–40-year-olds. Clark said that the top areas in claims spend were preventative care, as the population gets sicker on average; musculoskeletal issues, with 10–11% of claims – people will lose an average of 10 working days though these conditions; cancer, with a higher frequency of high-cost claimants and within younger age bands; mental health disorders, which have risen with an increase of 21% in claims and the interlink between mental health and physical health conditions; and pregnancy, as the fifth most costly in spend – lifelong fertility health support is something that helps the employer in the long run by meeting employee needs, and a personalised healthcare journey is suited to the complexities that can be found especially with overseas workers.

Clark pointed out that it was important to understand the point of view of the customer and that “claims are emotional, not just administrative”. She also stated that customers had a need for “simplicity, clarity, and personalised support”. Her final point was that it was more important in today’s world that the industry remained “agile, informed, and responsive” and providing solutions to the customers.

Langfield asked for a little more detail into the cultural nuances of healthcare benefits. Clark said that in the Japanese segment, for example, many employers required employees to have a wellness assessment, so support needed to reflect that, as well as providing Japanese-speaking doctors who know the cultural nuances so that the healthcare is reflective of expectations. Langfield said that failures in international assignments were often due to culture shock, and Clark said that families were deeply important in providing support for that, as were language services and other services to help the success of those assignments.

Sebastien Bedu, General Manager for the Middle East, International SOS

Bedu began by identifying that the world was more mobile than ever, with millions of travellers, expatriates, and remote workers that depend on timely, high-quality care. He said that this was a problem because there are many global healthcare systems that “remain uneven, complex, and costly to navigate”.

Bedu explained that there was a problem of misdirected cases, which could then trigger unnecessary escalations, complications, or evacuations. Bedu said that there was an average cost for healthcare of $15,000–$16,000 per employee per year. He said that common pitfalls in this area included patients presenting at non-accredited facilities; misjudged severity, leading to delays or overtreatment; and spiralling costs from unmanaged care pathways. He said that this led to poor outcomes, inflated claims, and damaged trust, and the way to prevent this started with “informed, medically governed case direction”.

Ensuring the right balance between medical integrity and cost efficiency, Bedu said, was a partnership between insurers and assistance providers, such that together they can:

• Enable accurate triage and early intervention
• Integrate local medical insight with insurer coverage frameworks
• Enhance member experience with multilingual support.

Bedu said that delayed medical intervention could increase costs by up to 40%.

To achieve positive medical and cost outcomes, Bedu emphasised that every medical case needed the right assistance at the right time. He explained that this was achieved through medical triage within minutes of a call, directing care based on verified clinical and network intelligence, and applying escalation matrices and governance to avoid unnecessary transfers, which would then result in shorter hospital stays, reduced complications, and controlled claims exposure.

Bedu illustrated his argument with a case study, showing how a repatriation of a patient on extracorporeal membrane oxygenation (ECMO) through several jurisdictions over an 11-hour journey could be performed with no complications, safely and cost-efficiently.

He continued by adding that getting patients to the right facility at the first point of contact was pivotal. Furthermore, Bedu pointed out that quality and capability varied across markets, so that networks must be evidence based and constantly updated to ensure that the right facilities were known. Bedu said that this intelligence-led network design “prevents misdirection and optimises care outcomes”. Bedu said that he believes that a tailored provider network is the difference between failure and success.

Bedu concluded that only by assistance companies working closely with insurers with directional care can they enable better healthcare delivery and cost-effectiveness, benefiting everyone.

Langfield wanted to ask about Saudi Arabia, as it is trying to attract expatriates, and what the challenges could be for these. Clark said that the regulations and rules were complex and didn’t exactly fit service provision, so, with the large growth, there has now been a lot of close work to make adjustments to account for this. Bedu said that the culture there was also changing at light speed, and taboos were also changing, for example with mental health troubles becoming a more accepted subject. He added that mental health support was a blind spot that is being filled.