Engage Health Group

Tag: claims trends

  • Bupa Global announces removal of their general pandemic exclusion during their first digital event

    Bupa Global took the opportunity to make this a global event, attended by key intermediaries from all over the world from the comfort of their own home / office. I’m getting quite used to sitting down with a cup of coffee for these, rather than jumping on a train for half a day, although I do miss the chance to catch up with a few old faces and in this case, some of my previous colleagues.

    Bupa Global speakers;

    • Paddy Watt, Commercial Director at Bupa Global
    • Dr Paula Franklin, Chief Medical Officer at Bupa Group
    • Sheldon Kenton, CEO at Bupa Global / GeoBlue
    • Rebecca Kett-Young, Head of Operations at Bupa Global 

    This event was the start of a new series called ‘Perspectives’, aimed to increase communication with the International Health Insurance market, and will be held regularly with the next session in September.

     

    Session 1: Exploring our new reality

    COVID-19 has, and will continue, to lead to disruption in the International Health Insurance industry and Bupa Global discussed three topic areas, showcasing how they have felt this impact and how they have dealt with it.

     

    How Bupa Global are supporting customers through the crisis

    Sheldon Kenton – CEO, Bupa Global and GeoBlue

    • The business stood up well to the immediate challenges created. It is a diverse organisation with many different operations and it saw the initial impact earlier than most other European headquartered businesses via its operations in in China and Hong Kong. This allowed Bupa to road test what would go on to become their global response and provided some advantages in maintaining their customer capability, allowing all 3,000 employees to work remotely while maintaining their turnaround times.
    • Despite the challenges faced, the NPS (Net Promoter Score) results, by which Bupa measure customer satisfaction, have continued to rise throughout this period.
    • With customers all over the world facing different access to, and capabilities of, care, Bupa worked hard to help steer members through this by creating a digital COVID-19 Hub. This is proactively supporting International Health Insurance customers with regular updates and is supported right across the Bupa Group.
    • Another response was to give every customer access to Global Virtual Care and they extended mental health benefits across all customers.
    • Between January and May Bupa Global’s Virtual Doctor service saw a 49% month on month registration increase
    • While International Medical Insurance claims have been suppressed during these month, core claims still continued, Bupa babies were still being born and cancer is still being covered as usual
    • A dedicated case manager has been assigned to every case of COVID-19, or which is suspected to be COVID-19 to help ensure the best support and clinical advice, as well as helping to manage some high cost International Health Insurance claims.
    • Bupa Global has also announced today that they are permanently removing the general pandemic exclusion from their International Health Insurance products moving forward.
    • Although they quickly announced that they would cover this pandemic in full, they wanted to reassure customers that this would continue, and that they would also now cover any future pandemic. This is good news for both their members and the market in general by removing uncertainty and bringing Bupa Global into line with the other major International Health Insurance providers.
    • There was an acknowledgement to the market feedback early on that Bupa Global didn’t come out to the market with their initial stance on COVID-19 as quickly as they might have done, however as a large organisation working through a lot of change, it was difficult to come out with an overview of their position, however they feel that now is the right time to make sure that they are providing more regular updates moving forward.
    • What can customers do if they are experiencing financial difficulties? Bupa Global already have processes and protocols in place for this scenario within their service team. They are sensitive to the issues and have had low levels of enquiries about ability to pay already. It will effective different customers in different ways and so a blanket statement isn’t possible, however Bupa are willing to try and support customers through this period where possible.

     

    The Global Picture

    Dr Paula Franklin – Chief Medical Officer, Bupa Group

    • Dr Franklin provided a recap on the symptoms of the virus and how it has emerged over the initial months, acknowledging that information and details of the disease are still evolving daily.
    • Reiterated that those at greatest risk are those
      • With an immune deficiency,
      • over 70,
      • under 70 with chronic heart, lung and kidney issues
      • with a BMI over 40.
    • Ethnicity and lower income populations are also reported to have had a worse experience with the virus, seemingly having experienced a higher risk of catching it, catching it more severely. Dr Franklin explained that this experience is driven by socio-economic factors, rather than clinical ones, with a range of reasons still being researched, but including;
      • Limited access healthcare
      • Densely populated living conditions
      • Cross generational housing
      • Populations with a higher level of chronic illnesses
    • Numerous government restrictions to reduce the spread of the virus have taken place around the world, mainly focused on restrictions on movement and increasing levels of testing.
    • The UAE and Saudi Arabia were two countries called out by Dr Franklin which had led the way, with establishing high levels of testing very early on.
    • By the 25th of January the UAE had already tested over 1 million people.  With two locations within the Emirate conducting door to door testing helping to identify, localise and contain the virus.
    • High levels of testing, used alongside contact tracing appears to be the most effective way to combat the spread of the virus.
    • The development of a vaccine, or vaccines, is being conducted at a pace truly unprecedented in medical history. A vaccine can usually take a decade, or longer to develop in normal times, even fast tracking is usually around 5 years. The aim of 12 – 18 months is extraordinarily fast and has been driven by high level of collaboration, not seen before, between both pharmaceutical companies and countries.
    • There are currently 150 vaccines in development and 19 already in clinical trials across the world.
    • Once, and if, a vaccine has been found, it then needs to be produced on scale, funded and distributed, so there is still a long way to go. How this further steps will be achieved remains to be seen
    • There will be ongoing consequences from the pandemic, not only economic, but broader health implications also. The delay in screening services, preventative treatment and potential chronic implications for some patients after having COVID-19 will all have an impact.
    • There is also a particular impact on mental health which is already starting to come through in research. The impact of being isolated and limitations on activities which people usually use to ‘decompress’ have had an impact and there is already clear evidence there will be a mental health burden due to the pandemic.  This will be have both a short term impact with stress and anxiety, but also longer term impacts where families and friends that have passed away and they are dealing with bereavement. People in the provision of care in general, not just hands delivery of care, are also expected to be impacted significantly. Experiencing trauma like this can often see a delay in mental health issues arising, sometimes an anniversary is a trigger, meaning we are likely to be dealing with this issues for a long while to come.
    • What happens to a vaccine if the virus mutates? This is common, the seasonal flu vaccine is annual for this reason and COVID-19 is being monitored and has already mutated, however these have not affected the behaviours of the virus so won’t impact the current vaccine work. If it does mutate significantly then yes, the vaccine would need to change and or adjust to respond to this.

     

    Impact to services and operational highlights

    Rebecca Kett-Young – Head of Operations, Bupa Global

    • Bupa Global experienced a sudden drop in International Health Insurance claims from February onwards, particularly in outpatient claims as private facilities shut around the world.
    • They saw a steady month on month decline, particularly in April which was 53% lower than March and 65% lower than January which was the last month with a normal claims trend.
    • Claims for May experienced a 35% increase compared to April, however were still 50% less than January.
    • Customers did still make claims and access cover, however, maternity and cancer claims were largely unaffected while some countries did continue almost as normal with no national lockdown.
    • To date, just under 250 Bupa Global members have been admitted into hospital with COVID-19, globally. All of which have been case managed and supported clinically.
    • All regions saw an increase in International Medical Insurance claims in May.
    • Most regions claims are still 50 – 60% down, other than China which is now back up to 95% of where it is expected to be.
    • During the pandemic 3,000 customers downloaded and accessed Bupa Global’s Virtual Doctor app and has proved a very popular tool from the feedback received.
    • Additional claims costs are expected moving forward as hospitals increase the use of PPE and cleaning regimes.
    • Uncertainty remains over what future claims will look like after they experienced a spike in claims in Beijing after the lockdown was eased there.
    • Bupa does expect a claims bounce back with many member accessing treatment which was delayed. They expect this could happen later this year or at the start of 2021 and are planning to ensure they have the employees in place to be able to maintain services levels at this time.
    • Bupa Global recorded a record score of +60 in their NPS claims feedback in June which has been consistently high, scoring +53 in March and April and +57 in May.
    • While some of the inpatient COVID-19 treatment has been expensive, this high claims impact is likely to be balanced out by a fall in claims elsewhere.
    • Bupa processes over £1Billion of International Health Insurance claims each year and this large scale helps in these scenarios and means the pandemic is unlikely to have a large impact on pricing moving forward.
    • The Bupa UK domestic business has offered members a financial rebate, however Bupa Global is unable to make the same commit at this time as their products and scope of coverage is very different. However they stated a clear priority to customers and will be fair and transparent with what they do commercially and are not looking to make any financial gains form the pandemic.

     

    Engage International is the specialist International division at Engage Health Group, supporting expatriates and high net worth clients with International Health Insurance UK, as well as offering a full range of broking and consultancy for businesses with an international footprint. 

    If you have any International Health Insurance needs, wish to discuss this article, or would like to discuss the broader International Employee benefits market in further detail, please get in touch.

  • COVID-19 Claims Trends: International Health Insurance (Aetna)

    COVID-19 Claims Trends: International Health Insurance (Aetna)

    Aetna International, one of the leading International Health Insurance providers, hosted their first virtual conference last week to their key partners.

    As well as being a great day and a chance to connect with the Aetna International team, we were provided updates on claims trends being seen during COVID-19 as well as details on how Aetna are working to simplify and improve member resources for their International Health Insurance members.

    Key updates

    • Donal O’Leary, Vice President International Actuarial & Underwriting, talked us through Aetna’s commercial experience to date and their view of the situation moving forward.
    • COVID-19 presents a complex and moving picture when it comes to assisting the commercial impact on the International Health Insurance market.
    • Firstly, in a pandemic situation there is ultimately a finite exposure as there is only a certain number of private beds and treatments available. There are a few factors that vary the impact seen as the pandemic rolls through over time and in difference regions;
      • Chronic conditions – it is still unclear which chronic conditions will develop and linger on after the initial illness and we are unlikely to fully understand this impact for a year
      • How long the pandemic lasts for – clearly the longer the situation goes on for, the higher the commercial exposure
      • Government support – This varies greatly by region and can also fluctuate, however good levels of government support allows firms to maintain benefits and staffing levels, holding up the revenue line.
    • The claims experience has varied significantly between countries with some markets experiencing significantly depressed claims for the first half of 2020, but others less so. Elective treatments have had the largest drop in March and April and are now returning to normal levels in markets initially heavily impacted.
    • Asia and the EMEA (Europe Middle East & Africa) regions have experienced the largest impact in H1 and this has driven some key learning;
      • Between March and May Aetna were seeing the stockpiling of medicines, what would usually be a 30 day prescription was coming in as a 90 day prescription,
      • The claims mix changes with less small claims, however more serious, high cost claims were less suppressed, particularly for cancer, heart conditions, strokes etc.
      • There has been some evidence of providers looking to recoup some of their losses via overcharging, an example given was a Russian hospital looking to charge for a CT scan for routine dental work. Their teams are now particularly vigilant to ensure they pick up this type of behaviour.
      • Evacuation benefit is included in all of Aetna’s International Health Insurance plans and these costs have been the main unplanned increase. Usually evacuations would be a mix of commercial flights and specialised medical transport which is much more expensive. Due to the lockdown of main countries, medical transport has been one of the only ways to move patients driving a significant increase in the use of private jets and a spoke in claims cost.
    • Aetna hasn’t experienced any bad debt yet, however if there is a second wave them government support will play a large pat in if that continues to be the case.
    • While claims have been lower, they aren’t as low as they had expected due to the reasons outlined above.
    • In the 2nd half of the year there is an increasing financial risk as delayed treatments catch up, although this may be a fairly smooth increase as people will still be anxious about going to some hospitals.
    • Supporting the increase in claims in H2 will be the adjustments that private hospitals have made in the last few months are initially being caught cold by the virus. They have now successfully introduced social distancing and introduced safe practises to be able to reopen within the current rules and well as significantly increase virtual client support.
    • Aetna expect there will be a significant increase in testing this winter as symptoms of common cold and flu are confused with COVID-19.
    • Aetna’s V health Virtual Doctor solution has, as you would expect seen an increase of almost 800% since global lockdown’s were put in place. This is partly fuelled by their decision to offer this to all of their members, whether it was originally included in their International Health Insurance plan.
    • Aetna expect this to drop off as lockdown’s ease, however they expect this to stay much higher than it was previously as the NPS score and feedback from the service has been so positive, so they foresee a behaviour change moving forward.
    • In EMEA Aetna have been providing premium credits to community rated SME clients to reflect the reduction in claims between April and June. They are committed to dealing with this as fairly as possible and pass back any profits they were not planned to make.
    • Aetna is focused on long term pricing sustainability and supporting their client relationships at this time.
    • For larger experienced rated groups they will be deducting April – June form the experience for that year and looking tin introduce profit shares to pass back unplanned profit.

     

    To round off…

    The experience has varied by country and Aetna haven’t experienced the drop in claims that they would have expected to, given the lockdowns in place, this has been driven by the broadly stable serious health claims and a spike in evacuation cost. Aetna are committed to not making any financial gains from the pandemic and will pass back any additional profits they make.

    Engage International is the specialist International team at Engage Health Group, supporting expatriates and high net worth clients with International Health Insurance, as well as offering a full range of broking and consultancy for businesses with an international footprint. 

    If you have any International health Insurance needs or which to discuss this article, or the broader International Employee Benefits market in further detail please get in touch.