Archive for the ‘Health insurance news from around the world’ Category

Global medical care update (European Union, Malaysia, Russian Federation)

Friday, December 17th, 2010

Good Neighbor Insurance, www.gninsurance.com , is continuing to update our clients on the global health and medical insurance changes.  Our blog at www.gntravelinsurance.com has many articles on global and US health coverage updates as well as understanding international travel insurance plans.  Feel free and call us at 866-636-9100 or  at 480-633-9500 here in Gilbert, Arizona.

EUROPEAN UNION 10-11-2010 / European Parliament committee approves cross-border health provisions

The public health committee of the European Parliament has approved a directive that is intended to improve the access to health care services for residents of one European Union member state who seek medical care in another member state. The approval was given on 27 October after the second reading. The draft directive means that an EU member state will be required to fully pay for the treatment received by a resident who seeks medical care in another country. Prior authorization of the treatment by the home country is not required unless the treatment involves hospital confinement or specialized medical care. Prior approval in such cases could be refused only in a very limited number of circumstances; in the case of refusal, the patient must receive clear and timely notice from his or her home country. The draft directive specifies that in most cases, treatment in another country is to be paid for only if the treatment is covered under in the home country.

During its review of the draft directive, the parliamentary committee introduced more than 200 amendments to the proposal from the European Council. Therefore, there will have to be meetings between the Council and representatives of the Parliament to resolve these differences. Once this has been accomplished, the final version will be returned to the full Parliament for a vote.

BACKGROUND
The draft directive attempts to clear up the uncertainty that patients often experience under the current rules–an uncertainty over whether payment will be made for a treatment and, if so, the timing of the payment and whether it will be sufficient to cover the cost. If adopted, the draft directive is expected to be of special help to those living in border regions who find it practical and convenient to receive medical treatment across the border from where they live.

There has been concern that the draft directive would encourage medical tourism and that it would allow a patient to financially gain from receiving care abroad. There also is concern that such a provision would distort the way in which a country provides medical care for its residents. The Council of Ministers–the ministers responsible for national health insurance coverage in each of the 27 member states–took more than a year to develop a proposed directive that would address concerns such as these.

EUROPEAN UNION 10-11-2010 / Third-Country Nationals now covered under EU social security coordination regime

A new provision extends the applicability of the social security coordination regime to include a third-country national who is a legal resident of an European Union or European Economic Area country who is working in a different EU/EEA country. For example, this would include a U.S. citizen who is legally resident in Belgium but who is temporarily assigned to work in Romania.

The current social security coordination regime, set forth in Reg. (EC) 883/2004 and Reg. (EC) 987/2009, took effect on 1 May 2010, replacing Reg. 1408/71 (EEC). Previously, the regulations omitted covering a legal resident of an EU/EEA country who is not an EU/EEA citizen, and who is working or staying in another EU/EEA country. The new third-country national coordination provision corrects this omission–except in United Kingdom and Denmark, which have exercised their right to opt out.

It will be noted that the United States, Canada, and other major non-EU/EEA countries have social security treaties with the principal EU/EEA countries and, therefore, their residents may not be affected by this change; however, they will benefit if they are working in one of the other EU/EEA member states where there are not treaties. (The US has social security treaties with 19 of the 31 EU/EEA countries: Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Norway, Poland, Portugal, Spain, Sweden, Switzerland, and United Kingdom.)

MALAYSIA 29-11-2010 / Malaysia considers mandatory health insurance for foreign workers

Malaysia is considering making it mandatory for foreign workers to be covered by private health insurance. This is part of the Economic Transformation Program (ETP), which is Malaysia’s plan to establish itself as a high income country by 2020. The ETP plan identifies 12 National Key Economic Activities (NKEA), one of which is private healthcare. The proposal to make private health insurance coverage mandatory for foreign workers is one of the six proposals (called Entry Point Projects) related to private healthcare.

RUSSIAN FEDERATION 29-11-2010 / Mandatory medical insurance bill passed a second reading

The State Duma of the Russian Federation passed the bill on reforming mandatory medical insurance in its second reading on 16 November 2010, two weeks later than originally planned. While no explanation for the delay was given, the law is expected to be finalized and approved by the end of 2010. The law will entitle patients to independently choose medical providers, medical insurance companies, and doctors.

No considerable changes to the draft law have been proposed since it went through its first reading in mid-October of this year. The only substantive change affects the revised mandatory insurance certificates (“polis”). As it stands now, new ‘polises’ will not be available to eligible individuals until 1 May 2011. Also, it will not be insurance companies but the Mandatory Medical Insurance Fund issuing these to the population.

Despite the anticipated timeline, the approval of the law may further be significantly delayed by the ongoing heated debates regarding possible amendments to the reform of the unified social tax (UST).

BACKGROUND
Earlier this year the UST was replaced with the social insurance contributions paid directly to each of the four funds — the Pension Fund, the Social Insurance Fund, the Mandatory Medical Insurance Fund, the Pension Fund and the Territorial Funds of the Mandatory Medical Insurance Funds. Starting 1 January 2011, the contribution rate is scheduled to increase to 34% (from the current 26%). There have been numerous requests by the business sector representatives that the government delays the increase. While the possibility is being discussed in the government, no firm decision has been announced yet, and the increase is still to take place as planned.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gninsurance.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes in global health care systems.

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Posted in Global updates 2010-2013 |

Health Insurance news from around the world: Hong Kong

Friday, December 3rd, 2010

The Hong Kong government is planning a health care change for 2010-2011 time frame.  In a budget speech given on 2-24-2010 the Financial Secretary informed all that the government plans to introduce voluntary medical insurance system.   This means the government is working on plans to help Chinese living in Hong Kong  move towards a private health care system to lessen the load on government programs currently in place.  The government is considering providing tax deductions for premiums.

This voluntary system to expand coverage is going to be the baseline standard of coverage for insurers.  Basic medical coverage package is being worked out and would exclude mental illness and congenital conditions.  Premiums would be based on age rather than experience.  Insurers are still rejecting the government’s push to include pre-existing conditions.

Hong Kong does not have a compulsory national health insurance program. Medical care is provided in both public and private facilities, though most emergency and hospitalization care is provided in public facilities and a majority of primary care physicians are in the private sector. Medical care is financed almost equally by both public (primarily general tax revenues) and private (out‐of‐pocket payments) resources. The cost of care varies based on whether the patient receives care in a public facility (where the government sets fees) or in a private hospital. The government‐set fees for public facilities are differentiated between those who are “eligible” (Hong Kong Identity Card holders under the Registration of Persons Ordinance) and those who are “non-eligible.” “Eligible” patients pay lower set fees.

Healthcare System Reform

Hong Kong is currently considering reform of the healthcare system.

In March 2008, the government launched a 3‐month healthcare reform consultation, inviting feedback from the public about how to financially supplement the healthcare system. The Food and Health Bureau presented 6 options for supplementing the system in a paper presented to the Legislative Council:

* Social Health Insurance: Employees contribute a certain percentage of their income to finance healthcare for the entire population.

* Compulsory Medical Savings Accounts (MSA): Certain portion of the population required to contribute to a medical savings account that would cover future medical expenses and/or purchase of approved medical insurance.

* Out-of-Pocket Payments: User fee increase for out of pocket payments at public health facilities.

* Voluntary Health Insurance: More people encouraged to buy private health insurance.

* Mandatory Health Insurance: Certain portion of the workforce required to subscribe to a regulated private health insurance scheme.

* Personal Healthcare Reserve: Certain portion of the population required to deposit part of their income to a personal account whose funds would serve as savings for future healthcare needs and be applicable to the purchase of mandatory insurance. A survey of employers found that the personal healthcare reserve (mandatory savings and insurance) was the most popular option and the social health insurance (employee contributions to finance public healthcare) was the least popular option.

Medical benefits

It is fairly common practice for Hong Kong companies to provide private medical benefits to employees and their families. The plan may be insured or self‐insured. Many insured plans use a Preferred Provider approach, whereby benefits are paid in full if they are provided by a doctor who is on the “approved” list of the insurer. Frequently, an employer will offer two or three levels of benefits – one for executives, providing care in a private hospital room; another level for managers; and a third, lower level for other employees (providing care in a hospital ward). Insurers also offer dollar indemnity plans (paying a specified amount for each day in the hospital, regardless of actual expenses), maternity benefit riders, and dental coverage. Normal exclusions from coverage include nervous and mental disorders, AIDS and HIV‐related conditions in the first five years of membership, cosmetic surgery, maternity expenses (unless covered under a rider), and general physical examinations. Many employers pay the full cost of coverage for employees; they pay half of the cost for dependent coverage. Employer and employee-paid premiums are tax deductible. Benefits are paid free of tax.

The government will plan later this year, 2010, to allow a public consultation period once the health care reform plan is finalized.  These reforms will not apply to insurance plans administered outside  Hong Kong.  This is good news for international health insurance plans that are based in the US.  This is another good reason to look at international health insurance plans that Good Neighbor provides. You may view them at our corporate web site at www.gninsurance.com .

Doug Gulleson loves to scuba dive overseas and he makes sure he always takes his Amex card AND international travel insurance policy.  Visit Good Neighbor Insurance at  www.healthinsuranceinternational.biz/gmmi.asp  for your next overseas trip and get a FREE quote.

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Health insurance news from around the world: Ireland

Friday, October 29th, 2010

Ireland has three private health insurance companies (VHI, Quinn Healthcare, and Hibernian Aviva Health) and they are increasing their premiums during 2010 by as much as 15%.  This increase reflects medical inflation and higher health insurance taxes.   The tax increase, per month, is from EUR 165 to EUR 180 for each adult subscriber and EUR 53 to EUR 55 for each subscriber younger than age 18.  This tax was introduced in 2009 by the Irish Supreme Court to subsidize health insurance costs for those 50 years old and older.

Ireland has a free government health insurance system if you do not count the taxes that all Irish pay towards this type of medical coverage.  The government-run health care system is modern and runs reasonably efficiently; however, free as it may be, you are also free to wait.  Waiting lists for those without private insurance can stretch for months and up to a year or two, even for critical – but non-emergency- operations like heart surgery.  Thus, with those waiting lines one is more apt to go with one of the three private health care plans in Ireland to get onto the “HOV” lane of medical care even though the premiums are high.

For maternity care in Ireland the system is very good when it comes to safety but it is not like in the US where most hospitals are like “hotel hospitals.”  So realize that your hospital experience when giving birth in Ireland will be safe and good but the setup is going to be plain and sparse.  The more important problem is getting proper care during the pregnancy and waiting lists for some obstetricians can be long.

The Irish government health care system is huge and is the nation’s single biggest budget expenditure as well as employer.  Ireland spends 8.2% of GDP on government health care, equivalent to $3,996 per capita. The Health Service Executive is the government body that runs the government health care system and their web site is http://www.hse.ie/eng/ .  Another good web site for information on the Irish government health care system is http://www.citizensinformation.ie/categories/health .  The major Irish health site is http://www.irishhealth.com/ .   The public government health care system is governed by the Health Care Act signed in 2004 which is responsible for providing health and personal social services to everyone living in Ireland and the new health service officially came into existence on January 1, 2005.  

Good Neighbor Insurance provides US style international health insurance plans that may fit your needs.  These plans may include maternity if you so desire as well as many other preventative coverages.  The IMG GMMI plans at  http://healthinsuranceinternational.biz/gmmi.asp are great options as well as our BUPA plans at http://www.onlineglobalhealthinsurance.com/ .   Do check all of our long term / career plans at our corporate site at http://www.gninsurance.com/career_plans.asp .

Doug Gulleson loves to scuba dive overseas and he makes sure he always takes his Amex card AND international travel insurance policy.  Visit Good Neighbor Insurance at www.gninsurance.com  for your next overseas trip and get a FREE quote.

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Health Insurance news from around the world: Taiwan

Friday, September 24th, 2010

Good Neighbor Insurance  provides overseas health insurance plans that cover those who are Taiwanese citizens and non-Taiwanese citizens.  Their plans cover all medical costs including maternity–if one wants to add that benefit to their policy.  Check out http://www.gninsurance.com/career_plans.asp for more information.

Taiwan’s healthcare system is financed through the National Health Insurance (NHI) system, funded by contributions from the government, employers, employees, and residents. Participation in NHI is compulsory for all employees, for citizens and residents with at least 4 months of residence in Taiwan, and for the dependents of these employees, citizens, and residents. 

Taiwan’s national health care costs are paid for by employer (60%), employee (30%), and government (10%).  As of April 1, 2010, the total health insurance contribution will increase from a 4.55% to 5.17% split by the percentages as shown above by the three groups.   The government will be subsidizing the increased cost for employees who earn less than TWD 53,000 a year. Employees earning between TWD 41,000 to TWD 53,000 annually will receive a 20% help from the government; for those earning under TWD 41,000 annually, the government will pay the total amount of the increase.

Eligibility

NHI covers all employees and their dependents because participation is compulsory.

Benefits

NHI will only cover expenses incurred from doctors and medical facilities under an Bureau of National Health Insurance (BNHI) contract. Coverage includes but is not limited to hospitalization, outpatient, Chinese medicine, dental, childbirth, physical therapy, home care, treatment such as hemodialysis (kidney failure procedure) for serious illness, emergency care, psychiatric care, and preventive care.  Co‐payments and outpatient user fees apply. For all inpatient and most outpatient care, co‐payments are 10% for stays under 30 days (capped at TWD 26,000 for each stay and TWD 43,000 for the year), 20% for stays longer than 30 days, and 30% for stays longer than 60 days. Co‐payments for prescription drugs range from TWD 20 to TWD 200, based on drug cost. Outpatient user fees range from TWD 50 to TWD 450, based on the type of care (outpatient, emergency, traditional medicine, or dental) and the type of facility (teaching hospital, regional hospital, district hospital, or clinic).

Medical benefits

Supplemental group health plans are commonly provided to supplement the NHI plan. The level of employer-sponsored benefits usually depends upon the classification of an employee’s position, with some plans offering the same benefit to all employees. Employee coverage is usually non‐contributory, and dependent coverage is usually contributory. A typical plan would include inpatient benefits and cancer benefits. Few employers provide outpatient coverage for employees because NHI already includes this benefit.

Doug Gulleson loves to scuba dive overseas. He makes sure he always takes his credit card AND international travel insurance policy. Visit Good Neighbor Insurance at  http://www.overseashealthinsurance.com/short-term.asp  for your next overseas trip and get a FREE quote.

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A look at Health Care Systems around the world…let’s grab some pasta in Italy!

Friday, July 16th, 2010

Italy’s national health care is rated second in the world by the WHO. However, a closer look shows that trouble plagues this system from a crippling bureaucracy, mismanagement, general disorganization, spiraling cost, and long waiting lines.

• The Italian constitution was changed in 2001 so that the national government now sets the “essential levels of care” and regional governments still control their budgets and resources to the local areas.

• Payroll taxes have a regressive structure starting at 10.6 percent of the first $30,000 of gross income and decreasing to 4.6 percent up to $100,000 gross income. The remainder of the funding comes from both federal and regional general taxation, including income and value-added taxes.

• In-patient and primary care are free at the point of treatment. However, co-payments are required for diagnostic procedures, specialist, and Rx drugs. The copays run around 30 percent of the services rendered. The elderly, pregnant women and children are exempt from the copays–which is nearly 40 percent of the population.

• Italians have limited choice of physicians. They must register with a general practitioner within their LHA. They may choose any GP in the LHA, but may not go outside it except for emergency care. A referral from a GP is required for diagnostic services, hospitalization, and treatment by a specialist.

• Most physicians are reimbursed on a capitated basis, which is based on the number of patients served over a given time period rather than the services actually provided. Some hospital physicians receive a monthly salary.

• Private health insurance is available in Italy but is not widespread. About 10 percent of Italians have private insurance, and the low percentage is due that one cannot opt out of the national care system.

• Waiting periods on average for medical care: 70 days for a mammogram, 74 days for endoscopies, and 23 days for a sonogram. This is due to shortage of modern medical technology.

• The US has two times as many MRI units per million people and 25 percent more CT scanners.

• Introduction of many of the newest and most innovative Rx drugs have been blocked by the Italian government to control Rx cost. • Conditions in public hospitals are considered substandard, particularly in the south.

• Dissatisfaction with the Italian health care system is extremely high, by some measures the highest in Europe. Fifty-five percent of Italians believe that it should be easier for patients to spend their own money on health care.

 Extra tidbits:

• The piano hails from Italy.

• The average life expectancy for an Italian is 79.54 years.

• The average Italian consumes half a pound of bread a day and 26 gallons of wine a year.

• If invited to someone’s home, the traditional gift is a tray of sweets from a pastry shop.

• With almost 40 million visitors, Italy is the fourth-most visited country in the world.

• The thermometer is an Italian invention.

• Italy is only slightly larger than Arizona, but has a population of more than 58 million.

Doug Gulleson loves to scuba dive overseas. He makes sure he always takes his credit card AND international travel insurance policy. Visit Good Neighbor Insurance at www.gninsurance.com/travel-A/international_travel_insurance.asp  for your next overseas trip and get a FREE quote.

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Health insurance news from around the world: Germany

Friday, July 9th, 2010

Germany’s Ministry of Health has stated they will have mandatory price negotiations on drug manufacturers as part of their health care reform.  One key element is to stop drug companies’ ability to set prices on new patented drugs without negotiating with insurers.   The Ministry of Health is also working towards:

*        A maximum price set for each drug.

*        Drug manufacturers will have to negotiate with health insurers for lower prices.

*        Drug companies would have to scientifically establish the use and value of new products.

*        Drug companies would have to show whether an innovative product is actually new or whether similar drugs already exist.

Note:  updated July 9, 2010 

Coalition leaders meeting in Berlin today agreed to raise health premiums to 15.5 percent of gross pay from 14.9 percent ( http://www.bloomberg.com/news/2010-07-06/merkel-raises-german-health-premiums-to-15-5-of-gross-pay-to-plug-deficit.html ).   Employers will contribute 7.3 percent with 8.2 percent paid by employees.  “We’re including everybody, workers, employers and taxpayers,” Roesler said in a statement distributed to reporters in Berlin.

Good Neighbor Insurance provides overseas health insurance for those traveling and residing outside the US.  Even though Germany has national health care that can be utilized by non-German citizens, what happens if you need coverage outside of Germany or back in the US?  This is where Good Neighbor Insurance can help.  Check out our career plans at www.gninsurance.com/career_plans.asp for a variety of options that may fit your needs. 

Doug Gulleson loves to scuba dive overseas and he makes sure he always takes his Amex card AND international travel insurance policy.  Visit Good Neighbor Insurance at www.gninsurance.com  for your next overseas trip and get a FREE quote.

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Global health insurance updates (Canada, Israel, Russian Federation, South Africa, Spain, and Taiwan)

Friday, June 18th, 2010

CANADA 05-31-2010 / Changes to Ontario drug plan changes postponed until end of June

The Ontario government has postponed its plans to lower generic drug prices, eliminate professional allowances, increase dispense fees, and set a limit for markup. The changes were initially intended to take effect in mid-May, but the government is still deliberating on the actual policies that will be put in place. Changes are not expected to be effective until the end of June.

Of the proposed changes, the one that is most certain to take effect is the elimination of professional allowances, the payments that drug companies provide to pharmacies to stock their products. The elimination of professional allowances was included in Bill 16, which the legislature passed on May 18th, 2010.

The following are the proposed changes to drug plans, both the public plan (Ontario Drug Benefit or ODB) and private plans.

Generic drug prices
The government has emphasized that limiting generic drug prices is one of the most important components of the proposed drug plan changes. The government’s proposal calls for a limit on generic drug prices of 25% of the retail/brand-name versions. This limit would take effect immediately for the public plan, which has a current limit of 50%, and be phased in for private plans, which currently are not subject to any limits. For private plans, the limit would be 50% in 2010, 35% in 2011, and 25% in 2012.

Mercer estimates that while generic drug prices are 30% to 80% of brand name versions, this average is skewed by the higher cost of drugs released since 2006, so the weighted average is about 55% to 65%. This would mean that significant decreases in generic drugs would not occur until 2011.

Professional allowances
The elimination of professional allowances would take effect immediately for the public plan (currently a 20% limit), and be phased in for private plans, which are not subject to regulations on these allowances. For private plans, professional allowances would be limited to 50% in 2010, 35% in 2011, 25% in 2012, and eliminated completely in 2013.

Dispense fees and markups
The government’s proposal only calls for changes in the public plan regarding the dispense fees and markups (for ingredient costs) that pharmacies may apply. For the dispense fees, the proposal calls for an increase from CAD 7 to CAD 8, plus a 2.5% annual increase as from April 1st 2011 for the next five years. The increase would be different (CAD 1 to CAD 4) in rural areas.

The proposal calls for the markup cap to remain 8% (same rate as before) but to be subject to a new cap of CAD 125 applicable for prescriptions in excess of CAD 1,500.

Observers expect for dispense fees and markups to increase for those on private plans as pharmacies attempt to generate revenue to replace losses caused by the drug price limits.

SPAIN 05-28-2010 / European Court of Justice to decide if Spain violates EU law by not paying for medical expenses incurred abroad

The European Commission contends that EU law is breached by Spanish legislation that allows reimbursement of hospital or non-hospital care received by a Spanish resident in other EU countries only in cases of “vital emergency.” The Commission points out that the EU regulation on the coordination of social security systems requires an EU country to grant authorization for treatment abroad when the conditions in the regulation are satisfied. Authorization only can be refused if the same or equally effective treatment can be obtained without undue delay in the patient’s own member state. The Commission says that Spain is acting unreasonably by systematically refusing to reimburse hospital costs when a request for reimbursement is submitted late; i.e., at the time of treatment or after the treatment. Thus, the Commission has asked the European Court of Justice to decide whether Spain will have to change its legislation on this matter.

ISRAEL 05-28-2010 / Court overturns inclusion of children’s comprehensive dental care in basic health benefits package

On May 20th  2010, the High Court overturned the government’s decision to include comprehensive dental care for children in the basic health benefits package (also referred to as a “health basket”). All Israel residents are compulsorily covered by a health insurance fund (Clalit, Maccabi, Meuhedet, or Leumit), and all funds are legally required to cover the services in the basic health benefits package.

This court decision overturns the Cabinet’s approval on May 2nd, 2010 of the Health Ministry’s plan to add dental care for children up to age 8 in the basic benefits package. This dental care was to include two check-ups and x-rays per year and a cleaning for free, and filings, extractions, and other services at a subsidized cost of ILS 20 each up to a cap of ILS 40 per visit.

Currently, the basic health benefits package only covers preventive dental care for children up to age 5. The health funds offer coverage beyond this minimum in supplemental policies. In its decision, the court stated that the approval of the Knesset (the legislative body) was necessary in order to add this new category of comprehensive dental care for children up to age 8 to the basic benefits package

Now that this comprehensive dental care coverage for children has been struck down, there is a push to return the ILS 65 million that was diverted for this coverage from the ILS 415 million in overall funding for the basic health benefits package. The government approved this allocation back in December 2009.

RUSSIAN FEDERATION 05-24-2010 / New law waives foreign worker quotas for “high skilled specialists”; social contributions payable for these employees

On May 20th 2010, the president signed into law a comprehensive package of revisions to the Federal Law No. 115-FZ (“On the legal status of foreign citizens in the Russian Federation”). These changes aim to create a more favorable legal framework for foreigners working in Russia. New provisions will come into effect on January 1st, 2011.

Previously, the amendments were approved by the lower house, the State Duma, on May 12th and approved by the upper house, the Federation Council, on May 13th.

High skilled specialists
The main novelty of the revised law is introduction of “high skilled specialists” as a new category of migrant workers. In essence, to be considered a high skilled specialist, an individual must be paid not less than RUB 2,000,000 annually. The Russian government reserves a right to lower this ceiling if necessary for the country’s economic futherment.

Employers are no longer limited by quotas on foreign workers when it comes to high skilled specialists. This is particularly important given the continuing trend of cutting foreign labor in Russia — in January 2010 the quota was reduced from 2,000,000 to 1,300,000.

While by definition foreign high skilled specialists must have experience, skills, or achievements in a certain area, employers are now entitled to establish the competency of such individuals on their own. They also do not have to obtain an authorization to employ a foreign expert (this particular provision becomes effective on July 1st, 2010).

Income tax for foreign high skilled specialists is set at 13%, the rate currently applicable to Russian citizens. For comparison: all other types of migrant workers are subject to 30% income tax.

High skilled specialists are not subject to the requirement to live in Russia for at least a year to become eligible for residency. Residency can be granted to high skilled specialists and their family members for a term of more than five years (based on the employment contract). High skilled specialists will be able to receive a legal resident status at the same time as the work permit.

Unskilled migrant workers
Unskilled migrant workers from the countries having no visa requirement with Russia will now have to provide their biometric information (photographs and fingerprints) to the country’s immigration authorities as of January 1st 2013. These workers must also obtain a “patent” (work license) in order to work in the country. The patent will cost a laborer RUB 1,000 per month. It will be issued for a term of 1 to 3 months and can be renewed for up to one year. According to the revised law, the patent or a rejection notification must be issued not later than 10 days after the application.

Work permits
Work permits to high skilled specialists will be issued for the length of their work agreements not to exceed 3 years. This permit can be renewed multiple times but no longer than for a 3-year period each time.. Additionally, the amended law established a new timeframe of 14 days for processing work permit applications. It currently takes from 12 to 23 months to process such paperwork. The purpose of the described amendments is to simplify the procedure of bringing foreign work migrants into the country.

In Russia, government regulation No. 681 from November 15th 2006 (“On the procedure for issue of permitting documentation to foreign citizens for performing temporary labor activities in the Russian Federation”) sets the rules for work permit procedures. Importantly, in 2009 Russian immigration authorities began to strictly enforce one of the regulation provisions that requires apostilles or consular legalized copies of foreign educational qualifications (diplomas, certificates of degrees etc.). Previously, notarized diplomas accompanied by translation would be accepted in most cases. Now a legalized copy of educational qualifications must be submitted with every work permit.

As an exception, notarized documents will still be accepted for 31 countries having mutual recognition of official documents with Russia. The newly enforceable rule equally applies to foreign workers submitting work permit applications for the first time and to those already working in Russia.

Health insurance and benefits for foreign workers
Employers must provide high skilled specialists health insurance, social security coverage, and accommodations. All the benefits must become effective on the first day of work of such individuals. Notably, high skilled specialists’ income is subject to social taxation as long as they have a legal resident status. Therefore, such individuals are entitled to medical insurance coverage and other social security benefits (temporary disability, maternal benefits) to the extent Russian citizens are.

Foreign workers temporarily residing in Russia (not having a legal resident status) are not entitled to medical insurance or any social security coverage.

BACKGROUND
During work permit application process notarized diplomas will be accepted from the following countries, no apostille required: Albania, Algeria, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Cuba, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Kazakhstan, Macedonia, Moldova, Panama, Poland, Romania, Serbia, Montenegro, Slovak Republic, Slovenia, South Korea, Spain (applies to documents issued by the Spanish Registry Office only), Tajikistan, Turkmenistan, Ukraine, Uzbekistan and Vietnam.

TAIWAN 05-31-2010 / Legislative committee completes first reading of draft bill amending the National Health Insurance Act

On May 20th 2010, the Health & Environment Committee of the Legislative Yuan completed its first reading of the draft bill to amend the National Health Insurance Act. This bill is primarily focused on the adjustments of premiums. It is not expected for this bill to be signed into law any earlier than 2011.

After this first review, the bill sets a new standard premium rate of 2.67%. This is lower than the previous proposed rate range (3-4%) because of the consideration of single insurers. The current total premium rate is 5.17% (split amongst employer, employee, and the government), which was raised from 4.55% in April. The same rate applies to individuals/ non-employees.

The draft bill proposes setting highest and lowest income limit to differentiate the premium for individuals with different levels of income. Those whose income exceed the highest earning ceiling of TWD 7.5 million per household will pay a monthly fixed amount of TWD 16,688 per person and those whose income fall below the lowest earning line of TWD 150,000 per household will pay a monthly fixed amount of TWD 334 per household. For those whose household income range falls between TWD 150,000 and 7.5 million, their premium will be calculated at the rate of 2.67%.

The basis of the premium calculation will be the total household income. In the first reading, the Health & Environment Committee of the Legislative Yuan was unable to reach a conclusion about whether the calculation of total family income should consider non-salary elements including dividends, rental income, pension income and donation. This particular provision will be sent to the Legislative Yuan for further debate.

The draft bill also states that expatriates who leave Taiwan for four years will only be able to resume participation in the national health insurance program after a six month waiting period.

So far, there has been no evidence that this legislation will affect the scope of covered medical treatments.

As the government and the opposition party have not agreed on several provisions of the legislation, the debate has continued on the unsettled issues. As the Legislative Yuan will adjourn after June 8th 2010, the third reading of the draft bill will likely to continue in the second half of 2010. The government expects the bill to be completely passed in 2011 and become effective by 2012.

The Executive Yuan (cabinet) initially submitted this draft bill to the Legislative Yuan on April 9th 2010.

SOUTH AFRICA 05-18-2010 / Task force appointed to develop guidelines for compliance with Medical Schemes Act

The Council for Medical Schemes (CMS), the statutory body that has responsibility for regulating approved medical schemes in South Africa, has appointed a 16-member task force to monitor compliance with the Medical Schemes Act and to develop a code of conduct for the industry. Particular attention is to be devoted to the obligations of the medical schemes to provide the legally-required prescribed medical benefits. The law requires approved plans to provide coverage for diagnosis, treatment and care of 270 listed diseases, 25 chronic conditions, and all emergency medical conditions.

The chairman of the CMS said that more than 4,500 complaints were received last year about unpaid accounts, benefit limitations, and denial of authorization to receive benefits; however, it has been estimated that about 90% of all complaints are settled or abandoned before they reach the CMS. Currently, there are more than 8 million members of approved medical schemes.

 Doug Gulleson loves to scuba dive overseas and makes sure he always takes his Amex card AND international travel insurance. Visit Good Neighbor Insurance at www.overseashealthinsurance.com/short-term.asp and trip cancellation options at our web site at  www.gninsurance.com/tripcancellation/  for your next overseas trip health coverage and get a FREE quote or call one of our agents at 480-633-9500.

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Posted in Global updates 2010-2013 |

Norway – A look at Health Care Systems around the world…let’s grab some Kroner

Friday, June 11th, 2010

We’ve all heard that the United States spends more (16 percent of GDP, or $2.10 Trillion) on Health Care than any other industrialized country. However, Norway, long heralded as a “shining example” of Nationalized Health Care, has its own problems to contend with. Norway’s overall tax burden, which is 45 percent of its GDP, ranks second only to Sweden, which has the highest tax burden among all the industrialized countries.

On any given day 280,000 Norwegians (out of a country of 4.6 million) are waiting for health care. Norway’s government has been trying to “legislate” these waits out of existence since 1990–successfully. 

An expert in medical ethics with the University of Oslo summed it up by saying, “It is important to see: (A) that in a public health service of the Nordic type, any given amount of resources always has alternative uses; and (B) it is neither medically nor morally defensible to put scarce resources to uses which will foreseeably yield less favorable outcomes than other uses–save fewer lives, cure fewer patients.”

While Norwegians generally report that they are “fairly satisfied” with the way their health care system is run, there has been growing discontent over such issues as the ability to choose a health care provider, involvement in decisions regarding care or treatment, and long waiting periods.

The average wait for hip replacement is more than four months; for prostatectomy, three months; and hysterectomy, over two months. It’s estimated that 23 percent of all patients needing hospitalization must wait at least three months for admission. This for a country ranked 11th in the world by the World Health Organization among industrialized countries (the US ranks 37th just ahead of last place Slovenia, and behind 36th place Costa Rica).

Norway at a glance:

Has the longest coastline in Europe.

 Has around 50,000 islands, and only 2,000 islands are inhabited.

  • Norway Vikings founded the world’s oldest parliament, the Lyn Wald, over 1000 years old.

Norwegians enjoy a very healthy diet, and they have one of the world’s highest consumptions of fish, milk, and cheese.

Norwegian inventions include the cheese slice and the paper clip.

Norwegian per-capita income ranks amongst the world’s highest.

Doug Gulleson loves to scuba dive overseas and makes sure he always takes his Amex card AND international travel insurance policy. Visit Good Neighbor Insurance at www.overseashealthinsurance.com/short-term.asp for your next overseas trip health coverage and get a FREE quote or call one of our agents at 480-633-9500.

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Posted in Europe |

A Look at Health Care Systems Around the World…let’s grab some fish-n-chips in England

Monday, March 29th, 2010

According to a recent study by the Cato Institute of Britain’s National Health Service (NHS), there is no perfect scenario when it comes to health care.  On one side of the spectrum is the desire to have unlimited medical care to extend one’s life as much as possible, and the other end of the spectrum is to ration care to control spending.

The NHS is a centralized government version of the one-payer system in England, and it pays directly for health care and finances the system through general tax revenues.  Most physicians and nurses are government employees.  Below are some key statistics to keep in mind when looking at a government system without competition.

*          Presently as many as three quarters of a million Britons are waiting to be treated in Briton’s hospitals. Cancer patients, for example, will wait as long as eight months before being treated. A byproduct of that wait is that maybe 20 percent of colon cancer patients, who were initially considered “treatable” when first diagnosed, will become “incurable” as a direct result of all that waiting. Even more alarming is the fact that as many as 40 percent of cancer patients have never even been seen by an oncology specialist.

*          In 2008 Briton’s goal was for a wait time of no more than 18 weeks.  The study showed that only 30-50 percent of patients actually received treatment within the 18-week time frame. What’s worse is that only 20 percent of orthopedic and trauma patients received care from a specialist within the18-week target window.

*          Not surprisingly, a direct result of Briton’s over-taxed system is that certain types of care for more expensive procedures such as open heart surgery and kidney dialysis are now “rationed.” Even more alarming is that patients deemed “too ill” or “too old” for a procedure to be “cost-effective” are being denied treatment altogether. One government “solution” being proposed is that the NHS be allowed to refuse treatment to those with “unhealthy lifestyles” such as smokers and the overweight.

*          Another solution is “competition” in the form of private health insurance. Currently about 10 percent of Britons have private health insurance, and that number is growing, as more and more Britons seek to gain access to a wider choice of healthcare providers and avoid waiting lists.

*          Studies conducted on the British public indicated that 63 percent felt the need for healthcare reform is “urgent,” and another 24 percent believe that it is at least “desirable.” Even more telling, however, is that 60 percent of Britons believe that making it easier for patients to spend their own money on health care would “improve quality.”

Doug Gulleson loves to scuba dive overseas. He makes sure he always takes his credit card AND international travel insurance. Visit Good Neighbor Insurance and view the BUPA plans at   http://www.onlineglobalhealthinsurance.com/   for your next overseas trip and get a FREE quote.

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Posted in Europe |

Spain – A look at Health Care Systems around the world

Monday, March 8th, 2010

Spain’ national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions.  The Spanish Constitution guarantees all citizens the “right” to health care- including equal access to preventative, curative, and rehabilitative services.  Coverage under the Spanish system is nearly universal, estimated at 98.7% of the population.  The federal government provides each region with a block grant.  The money is not earmarked – the region decides how to use it.

Spanish patients cannot choose their physicians, either primary care or specialist.  Rather, they are assigned a primary care doctor from a list of physicians in their community.  If more specialized care is needed, the primary care physician refers patients to a network of specialists. One may not go “out of network” unless the patient has private health insurance.  This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting list.

Waiting lists vary from region to region but are a significant problem everywhere.  On average, Spaniards wait 65 days to see a specialist, 71 days to wait for a gynecologist, and 81 days for a neurologist.  The mean waiting time for a prostectomy is 62 days and for hip replacement surgery is 123 days.  Some health services that US citizens take for granted are almost totally unavailable.  For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives.  There are few public nursing and retirement homes, and few hospices and convalescence homes.

As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative.  About 12% of the population currently has private health insurance.  Overall, private insurance payments amount for 21% of total health care expenditures.  More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24% of health care spending in Spain is out of pocket – more than any European country except Greece and Switzerland, and even more than the United States.  Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.   Good Neighbor Insurance brokerage firm, at www.gninsurance.com , provides private health insurance coverage in Spain for US and non US citizens via international health insurance plans like BUPA, IMG, HTH, HCC, and other overseas health insurance companies.

There are also shortages of modern medical technologies.  Spain has one-third as many MRI units per million people as the US and just over one-third as many CT units, and fewer lithotripters.  Some regions, like Ceuta and Melilla do not have a single MRI unit.  All hospital-based physicians and approximately 75% of all other physicians are considered quasi-civil servants and are paid a salary rather than receiving payment based on services provided.  As a result Spain has fewer physicians and fewer nurses per capita than most European countries and the US.

Even so, Spaniards are generally happy with their system where nearly 60% describe their system as good, the second highest favorability rating in Europe. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with the waiting lists.

Quick facts:

  • The biggest industry in Spain is tourism
  • Madrid, Spain’s capital city, is located in the exact center of the country
  • The low birthrate registered in Spain is the result of the high unemployment, coupled with steep housing cost.  These factors make it difficult for most people in Spain to buy houses big enough to accommodate more than two children
  • Spanish (Castilian Spanish) is not the only language spoken in Spain.  There are at least four other major languages spoken plus other variations and dialects.  The major other languages are Galician, Basque, and Catalan
  • You won’t find corn or flour tortillas in Spanish food.  In Spain, tortillas are a popular egg and potato dish
  • Soccer is Spain’s most popular sport
  • Around 40% of Spaniards between 17 and 24 are smokers
  • Spain has one of Europe’s highest rates of AIDS
  • Prescription medications can be acquired over the counter at medicine shops

Doug Gulleson loves to scuba dive overseas and makes sure he always takes his Amex card AND international travel insurance. Visit Good Neighbor Insurance at www.overseashealthinsurance.com/short-term.asp for your next overseas trip health coverage and get a FREE quote or call one of our agents at 480-633-9500.

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Posted in Europe |