The rewards of a cross-border assignment can be many for expatriate employees and their accompanying family members, with new environments, cultures, colleagues, and customs to explore. But they can also pose unique challenges that, without proper preparation, can cause serious anxiety, stress, or financial hardship.
The need for urgent medical treatment can be one of those risks. Most assignments occur without issue, but it’s important to be aware of the available options should an employee or a family member need urgent care while living and working in another country. Most individuals on assignment have some form of medical insurance or policy in place which would support non-urgent care effectively and efficiently. In fact, some countries stipulate proof of such coverage as part of the visa application requirements. But what happens if individuals or family members do not have adequate insurance, or experience an emergency that cannot wait for private provider treatment?
The rules surrounding the use of a country’s medical facilities can be confusing. Given the sheer nature of when they are required, navigating the system can understandably lead to a lot of anxiety and concern. As a general rule, most countries will provide urgent emergency care when required without question. The issue of eligibility and potential payment, however, can come into effect once the immediate need has passed. Where does this leave those without medical insurance, or insufficient levels of coverage?
Regional Approaches
In some countries, such as Spain, provided the individual is making local social security contributions, as is typically done when local employment contracts are held, then access to the full healthcare system is free of charge.
Singapore allows access to the public health system to visa holders, albeit not at the subsidised rates enjoyed by Singaporean citizens and permanent residents.
In the UK, visa holders have typically already paid a healthcare surcharge in the event that use of the National Health Service (NHS) is required. This allows full use of the NHS and any treatments it provides, although dental services and prescriptions are still payable, just as they are for most UK residents. The charge is a set amount, with the only variance determined by the age of the applicant, or if the applicant is applying for a student or youth mobility scheme visa (a working holiday / backpacker type visa).
The amount is a set annual sum, to be paid at the time of application. There are no refunds should medical treatment not be required during the individual’s time in the UK. The current charge is set at £776 per year of visa for those aged under 18 or student / youth mobility applicants and £1,035 per year for all others. It’s important to consider that while the annual fee may seem high, particularly on longer-term visa applications, it is still generally lower than the cost of major treatment.
The introduction of the Immigration Health Surcharge (IHS) in 2015 removed the ability for a visa holder to incur significant healthcare debt. However, there may still be individuals who are liable for the cost of medical care received before its enactment. Any individuals holding such debt can be prevented from qualifying for any new visa or for permanent residency in the UK, something that can be incredibly impactful on an individual’s future plans.
In the United States, most of the healthcare is covered by private providers through paid insurance policies. While government funded healthcare does exist, the circumstances for eligibility are generally not applicable to assignees.
The U.S. has had a long-standing “Public Charge Rule” that allows the government to deny visas to applicants deemed at high risk of becoming dependent on government assistance. Its most recent update in December 2022 essentially reaffirmed previous guidance and confirmed that immigrants are entitled to use healthcare provisions for which they qualify, such as Medicaid, without impact on their immigration status. Eligibility for Medicaid, an umbrella term for government funded medical care assistance, is dependent on numerous factors including geographic location, salary, and family status, but is typically provided to low-income individuals.
Employers should be aware that any visa holders deemed at risk of being dependant on long-term care at government expense could be denied any future immigration status. The specifics surrounding the public charge concept and interpretations of its rules, definitions and scope have come under scrutiny during various administrations. If history is any indicator of possible future events, further changes to the public charge rule could be forthcoming. As with all major changes to immigration rules, Sterling Lexicon will monitor and inform on their impact to the talent mobility industry.
Conclusion
Most countries do not operate a free-for-all healthcare system or use a health surcharge, but instead tend to operate on the basis that any needed treatment will be provided and an invoice will be issued to cover the costs.
As those costs can quickly add up, it’s prudent for expatriates and their family members to have adequate medical insurance to ensure any required treatment can be provided efficiently and economically.