International Health Insurance for Expats and Long-Term Travellers: The Complete Guide

Short-term travel insurance covers emergency treatment while abroad for trips of a few weeks; it is not designed for people who live, work, or retire in another country. An expat, digital nomad, or person relocating for an extended period needs international health insurance: a policy that provides comprehensive healthcare coverage regardless of which country they are in, at the standard they would expect at home rather than the emergency-only floor that travel insurance provides. The market for this product is dominated by a handful of global providers, and the difference between the best and worst policies is significant in both coverage and cost. The key decision is coverage region: including the USA in your coverage territory nearly doubles the premium and is only justified if you regularly travel to or through the United States.

Who Needs International Health Insurance

Four distinct groups benefit from international health insurance rather than standard domestic or travel insurance:

• Expats and corporate relocatees: Employees or contractors living in a country other than their home country for 6 months or more. Their domestic health insurance (NHS cover, for UK citizens) typically does not follow them abroad beyond emergency treatment; some countries require proof of private health insurance for visa applications.
• Digital nomads and location-independent workers: People who move between multiple countries continuously and have no single country of residence. Standard travel insurance policies have limits on trip duration (typically 30 to 90 days per trip); international health insurance has no per-trip limits and covers ongoing medical care including specialist visits, dental, and mental health.
• Retirees abroad: UK citizens who retire to Spain, Portugal, France, or further afield no longer have automatic reciprocal healthcare access after Brexit (the S1 form entitles UK state pensioners to state healthcare in EU countries if registered, but coverage varies and private insurance is often necessary for timely access to treatment).
• Students and researchers abroad for extended periods: Most university study abroad programmes require proof of health insurance; US universities in particular require coverage with minimum limits that exceed what standard UK travel insurance provides.

How International Health Insurance Works

Unlike travel insurance (which reimburses costs after treatment) or domestic insurance (which requires registration with a local insurer), international health insurance typically works through a combination of direct billing arrangements with hospital networks and reimbursement for treatment outside those networks. The largest providers maintain networks of hospitals and clinics in major cities globally; for treatment within the network, the insurer pays the provider directly and the policyholder may owe only an excess. For treatment outside the network (in a country where the provider has no arrangement, or in a facility not included), costs are paid out of pocket and reimbursed according to the policy terms.

Major Providers Compared

Cigna Global

Cigna is the most widely recommended international health insurer by expatriate communities and independent broker comparison sites. The Global Health Options plan offers four coverage tiers (Silver, Gold, Platinum, and Diamond) with different deductibles (£/$/€0 to £5,000) and benefit limits (annual outpatient benefits from £5,000 to unlimited). The provider network is extensive in Europe, Asia Pacific, and the Middle East; thinner in Latin America and Sub-Saharan Africa. Digital claims submission and a 24/7 helpline staffed by medical professionals are consistent positives in user reviews. Annual premium range: £1,200 to £4,500 per person depending on age, region, and plan tier.

Aetna International

Aetna's international plans are particularly strong for coverage in the USA (useful for expats who travel regularly to the US), Latin America, and Asia. The Navigator plan structure allows significant customisation of benefit levels. Aetna's direct billing network in Asia is rated as stronger than Cigna's by independent broker assessments. Annual premiums comparable to Cigna; the USA inclusion add-on is typically £800 to £2,000 per year additional.

AXA Global Healthcare

AXA's international plans are well-regarded for European coverage, particularly France, Germany, and Southern Europe. The plans structure benefits clearly and the claims process is rated as straightforward by brokers. AXA's strength is its European footprint; coverage in Southeast Asia and the Middle East is adequate but not class-leading. Annual premium range: £1,000 to £4,000 per person.

Allianz Care

Allianz Care (formerly DKV Globality) provides international health insurance with a particular strength in German-speaking markets, France, and the Middle East. The Choice plan structure allows flexible benefit selection. Widely used by corporate relocation programmes. The 24/7 medical advice line and app-based claims submission are consistently well-reviewed.

Key Coverage Terms to Understand

• Coverage area: Most plans offer tiered geographic coverage with "Worldwide excluding USA/Canada" as the cheapest tier and "Worldwide including USA/Canada" as a more expensive option. USA inclusion adds 60% to 100% to the premium because US healthcare costs are 3 to 5 times higher than equivalent treatment in Europe or Asia.
• Pre-existing conditions: International health insurance excludes pre-existing conditions by default. Conditions must be declared at application; cover for pre-existing conditions, if available, is either excluded entirely or added at a premium surcharge through individual medical underwriting (IMU).
• Moratorium vs full medical underwriting: Moratorium policies exclude any condition for which you received treatment, advice, or medication in the past 2 to 5 years, but may provide coverage after a claim-free period for those conditions. Full medical underwriting (FMU) requires a detailed medical declaration at application but provides greater certainty about what is and isn't covered from the start.
• Outpatient vs inpatient cover: Inpatient cover (hospital stays, surgery) is typically included in all plans. Outpatient cover (GP visits, specialist consultations, diagnostic tests) is often an add-on or limited in cheaper plans. For people using healthcare regularly, comprehensive outpatient cover is essential.
• Dental and optical: Standard plans do not include dental or optical. These are add-ons, typically £150 to £400 per year additional, and are worth adding for expats who use dental care regularly.
• Mental health: Increasingly included in standard plans, but coverage limits (number of sessions per year, maximum annual benefit) vary considerably. Cigna and AXA both include 30 to 40 outpatient mental health sessions per year in their higher-tier plans.

How to Save on International Health Insurance

• Use an independent broker (Pacific Prime, Expatriate Healthcare, or William Russell are well-regarded) to compare plans across providers; brokers receive commission but do not charge the client and can access plans not available directly
• Choose "Worldwide excluding USA" coverage unless US travel is genuinely regular (4+ trips per year)
• Increase the annual deductible (excess) to £1,000 to £2,500; this reduces premiums significantly and makes economic sense if you are otherwise healthy
• Consider a regional plan rather than worldwide: a Southeast Asia plan from Pacific Cross or Allianz covers Thailand, Vietnam, Singapore, Malaysia, and neighbouring countries at substantially lower cost than a global plan

Related: Digital Nomad Visa Guide: Tax, Residency, and the Best Programmes | Travel Insurance for Pre-Existing Conditions: What You Need