Live Chat Admitted vs. Surplus Lines vs. ACA Compliant medical plans
eGlobalHealth > Admitted vs. Surplus Lines vs. ACA (ObamaCare) Compliance
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Key concepts you will want to understand before making decisions about your coverage choices

We presently offer several top carrier choices for international major medical insurance, ranging from GeoBlue / HTH to International Medical Group to Seven Corners.  These three carriers in particular offer vastly different coverage and benefits.  Our goal on this page is to try and point out key pit falls to be aware of when considering your personal situations and medical insurance needs globally.

Specifically, GeoBlue / HTH is the ONLY USA admitted insurer we offer, whereas IMG and Seven Corners are insured by "offshore" or surplus lines insurance carriers like Lloyds, London among others.  You will want to become familiar with the pit falls that non-admitted carrier plans may pose (we'll talk about this later on down the page).

So, what does this mean as far as the Affordable Care Act (ACA) ?

As of October 1st, 2013 (the day that the ObamaCare (ACA) marketplace was "unsucessfully" rolled out in the United States), it means much more than it did before this critical date.  The entire landscape of health insurance and health care, both domestically in the USA and abroad globally for US citizens , changed forever.   If you are NOT a USA Citizen / Tax Payer and living abroad, then ACA will not affect you (as far as we can tell as of late 2013).

The Affordable Care Act (ACA) will officially be active as of January 1st, 2014.  If you have not kept up with the news on how the new laws might affect you, we highly recommend doing your own research and also consult your financial advisor and/or tax accountant as to how the new ACA legislation could adversely affect your pocket book and overall health insurance position for you and your family.

  Granted the new ACA law in theory provides 10 Key Coverages that everyone would love to have ... the problem is the costs to sustain such a program are still yet unknown and the medical insurance premiums, so far, are sometimes 50-300% increased over a pre-ACA medical plan.  As of this writing in late 2013, the debate is still heated on this point as many folks are getting notices of cancellation from their current domestic health insurance carriers.

So, if you are a USA citizen (tax payer) and living abroad, you must take note on the rules ACA has put forth regarding your compliance with the law.  Just because you are living outside the USA does not preclude you from being absolutely exempt from penalty by the Internal Revenue Service (IRS).

As of this writing, we understand the regulations to define those persons who reside outside the USA for 335 DAYS (approx 11 months) or more PER YEAR would be exempt from any penalties regarding the ACA.  If you however, come back stateside for 35 DAYS or longer... wham ! You get hit with the IRS tax penalty... that is, unless you purchase an ACA compliant plan stateside, as well as your overseas plan (keep in mind that the ACA plans won't cover you outside the USA, similar to that of Medicare).   So you would need to purchase something a kin to the GeoBlue Xplorer Essential covering worldwide Excluding in the USA.

Presently no program we offer (or anyone offers for that matter) is an ACA compliant "international major medical plan", not even the individual GeoBlue programs as of this writing.  Therefore, just purchasing a worldwide coverage plan from say GeoBlue would not pass the "ACA test".  The only way you'd be okay is if you were truly outside the USA a complete 11 months per year !   You can see the significant dilemma ?

For example, as of 2014, a missionary family, living and residing in Italy, but travel back to visit family a couple times per year that add up to more than a month or two, would be taxed under ACA, IF they don't ALSO have a state specific ACA approved plan for the entire year (or I think at a minimum 9 months -- it's a complicated set of rules).  The flip side is if you don't get the ACA plan (typically $3000/ year for a Bronze Level Plan) for use only in the USA, you can opt for the IRS tax penalty which is on average 1% of your gross income.  Never has it been more critical that you consider all the factors.

Ok, so what is the deal with admitted vs. off shore carriers ?

As an independent brokerage agency offering special risk health, life and disability insurance globally, we realize not just one plan will meet everyone's particular needs, thus why we offer choices (not unlike the way a large retailer offers several brands and styles of coffee makers, clothing, etc).  The options we provide are considered in the industry to be of the top-rated special risk carriers in the world with A ratings or better, whether US carriers or Surplus Lines carriers (to be distinguished in detail below).  The simple fact is that not all our clients want the most expensive plan available, as many will base their decisions 80% of the time on a lower premium cost (up front cost to buy the plan).  This might be similar to how a person shops for the coffee maker I alleuded to earlier.  A basic model may work for a person most of the time. Understanding the benefits and uses of "each coffee maker" is important though.

One important point is that I hate comparing buying a coffee maker to buying health, life or disability insurance.  It is easy to get another coffee maker, but not so easy to get another health insurance plan, especially if you find the plan you are on will not cover certain pre-existing ailments or conditions or other possible exclusions that are always outlined in the policies prior to the consumer purchasing them.  We would hope our clients (YOU) are fully informed, educated and aware of the issues at hand regarding what questions and scenarios are important to the longevity of your insurance needs.  We recommend that if there is any concern or questions, that you contact one of our licensed brokers to assess your needs and from that a sound decision can be recommended.   [ But wait a minute, didn't we just talk about ACA plans and that they DO cover "pre-existing conditions"? -- yes, we did but remember that "international style "medical plans are as of yet not ACA compliant and as such do have limitations to covering pre-existing conditions... keep reading].

Many of the programs in the marketplace today are from the Surplus Lines side of the equation -- that being typically underwritten by Certain Underwriters through Lloyds of London, etc. (IMG is backed by a Swedish insurer and Seven Corners is backed by Lloyds).  For many scenarios, especially for those "non-US resident / non-US citizens" or US residents residing in an unapproved state, the Surplus Lines programs are typically the only choices available (US admitted programs are NOT available to non-US citizens / non-residents).    

For those US residents / citizens (including non-US citizens actually residing in certain US approved states or regions), they are eligible for the Admitted carrier programs as well (in most cases).  It then becomes a matter of weighing the options and considering the individual circumstances of the case as to whether an individual or family chooses to go with the Admitted vs Non-Admitted (Surplus Lines program).  For all intents and purposes, it is our strong recommendation that if you are eligible for an Admitted / U.S. insured program, then you really need to be looking at those options first (in this example it's the GeoBlue Xplorer program).

To begin, Admitted policies are approved by U.S. state specific insurance regulators and the policy definitions & contract wording need to conform to strict standards set forth by such regulators, state by state.   Non-admitted carriers (ie; Surplus Lines like Lloyds of London, etc) are not required to follow any particular US or State regulations.

One case in point, the Pre-existing language can be very different between an Admitted and Surplus Lines health insurance program.  As a result, admitted wording tends to be more consumer friendly (from a US-centric standpoint). Even though you may very well pay more for an admitted plan, it could end up being that you could, in certain circumstances, pay more in the long run, especially if you thought your pre-existing ailment or condition would be covered under your plan and it turns out it is excluded due to specific language or exclusionary riders placed on the policy prior to your acceptance in the program. 

The point here is that the least expensive insurance policy could be the policy that does not cover a particular claim, especially when dealing with pre-existing conditions.  We recommend that all our clients review each policies brochure and certificate wording prior to binding coverage, to see what the exclusions and benefits are exactly.  If there are any issues noted within the exclusionary wording of the policy or if you have a condition that might warrant you needing stronger language to cover your pre-existing condition, we recommend reviewing those products we offer that follow U.S. regulatory guidelines or to contact one of our broker / agents directly to help assess your situation.

Examples of Admitted vs Non-Admitted Pre-existing Condition Definitions & Policy Wording

FACT - Pregnancy (no matter how far along you are) IS a pre-existing condition & NO insurer will ever be willing to offer you Pregnancy insurance after the fact, let alone offer ANY health insurance while pregnant.

See below for actual policy wording. The non admitted (Surplus Lines) wording leaves the customer potentially exposed. Imagine buying a policy and 18 months later you begin to experience chest pain and shortness of breath. You discover that you have a blockage in your arteries and require heart bypass surgery. Under an admitted policy, the expense associated with this surgery would be covered. Under a non admitted plan (Surplus Lines) this claim could be denied because with reasonable medical certainty your arteries have been closing over time. It could be argued with reasonable medical certainty that this condition manifested itself slowly over time (any time). Under a non admitted (Surplus Lines) policy it is irrelevant that the patient was not experiencing any symptoms prior to the policy effective date.

U.S. / Admitted Definition of Pre-Existing Conditions:

Pre-existing Condition means a medical condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months immediately preceding the Eligibility Date. 

Non Admitted (Surplus Lines) Definition of Pre-Existing Conditions (definitions may vary slightly from one carrier to the next):

Pre-existing Condition: Any Illness, Injury or Mental or Nervous Disorder that, with reasonable medical certainty, existed on or at any time prior to the initial effective date of this insurance, whether or not previously manifested or symptomatic, diagnosed, treated or disclosed on the Application or any Claim Form or otherwise, including any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting therefrom.


Admitted Exclusion Language:

Pre-existing Conditions Exclusion

Benefits are not available for any service received: (1) on or within 6 months after the Eligibility Date of an Insured Person who is not a late enrollee or (2) on or within 6 months after the Effective Date of Coverage for a Late Enrollee, if those services are related to a Pre-existing Condition. This exclusion does not apply to a Newborn who is enrolled within 31 days of birth or a newly adopted child who is enrolled within 31 days from either the date of placement of the child in the home, or the date of the final decree of adoption. In addition, the insurer will credit time an Insured Person was covered by Creditable coverage that was in effect up to a date no more than 63 days before the effective Date of Coverage under this plan, excluding the Waiting Period.

This limitation does not apply to the Medical Evacuation, Repatriation of Remains and Bedside Visit Benefits.

Non Admitted (Surplus Lines) Exclusion Language:

Pre-existing Conditions Exclusion

Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twenty four (24) months and thereafter such Charges are limited in coverage to $5,000 per Period of Insurance ($50,000 lifetime maximum).

* Note: you may also find that if a carrier accepts you under the program they can very well still attach exclusionary riders to the policy for anywhere from 6 months to forever.  Be aware of noting the rider exclusions (if any).

Still have questions, please contact us or view our Frequently Asked Questions (FAQs) page.

< Information on this page is updated as of October 25th, 2013 >
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