Health is one of the main risks of living abroad, and medical insurance addresses it from two sides at once: formally (you won't get a visa or residence permit without a policy) and practically (access to proper healthcare and evacuation if something happens far from home). It makes sense to select a policy at the preparation stage for relocation: program requirements and processing times often turn out to be strict constraints, and searching for insurance at the last moment is risky.
Context: the expat insurance market
The separate expat insurance market grew out of corporate needs: for decades, international policies were issued to diplomats, oil and gas company employees, and those sent abroad by their employers on business trips. In the 2010s, a new audience joined them—relocators and digital nomads who move on their own and buy policies directly. This is how a niche corporate product turned into a mass-market segment with dozens of providers and online enrollment.
There is almost no official market statistics: regulators do not track international private medical insurance separately, so the overall volume is difficult to estimate. However, the largest players are visible. Cigna claims 86 million clients in more than 200 countries and a vast network of clinics and doctors; Bupa Global operates in approximately 170 countries, Allianz Care is represented in more than 200 territories, joined by AXA and BCBS Global (GeoBlue). Competition and online enrollment have made policies accessible not only to corporate clients but also to private relocators and digital nomads.
Concept
For a relocator and digital nomad, health insurance is a mandatory element of relocation on par with a visa and housing. It has two roles: legal (visas and residence permits directly require a policy) and practical (access to quality healthcare abroad and evacuation in an emergency). Two classes of policies coexist in the market—international and local; the choice between them is determined by lifestyle and the requirements of a specific program. It affects both the price and whether the policy will continue to work after the next move.
When insurance is mandatory
A Schengen visa requires travel medical insurance with coverage of at least €30,000: it must include hospitalization, emergency care, and repatriation, including in case of death, be valid in all Schengen countries, and cover the entire duration of the trip. Similar requirements are built into long-stay visas: the Japanese digital nomad visa requires private insurance with coverage from 10 million yen, UAE visas and residence permits require a policy valid in the country. Therefore, it is logical to select insurance immediately according to the requirements of the program under which the application is submitted.
Global or local
An international policy (international private medical insurance) covers treatment in several countries, transfers when relocating, includes medical evacuation and repatriation, provides a choice of clinics, and often direct settlements between the insurer and them. A local policy is tied to a country and a network of medical facilities, costs less, but may not work abroad. For settled residence permits, a local insurance policy recognized by the local program is often sufficient; for a mobile life with frequent moves, an international policy that does not need to be reissued at every border is more practical.
What to look for in a policy
Key parameters are coverage zone (worldwide or worldwide excluding US, since the US dramatically increases the policy cost), overall limit of liability, coverage composition (outpatient and inpatient treatment), attitude toward pre-existing conditions, availability of medical evacuation and repatriation, and the possibility of direct settlements between the insurer and the clinic. For visa purposes, it is additionally verified that the insurer is recognized by the program and that the amount and conditions meet its requirements.
Regulation by country
Specific requirements are set by the entry program, so regulation should be studied before purchasing a policy. A familiar benchmark for everyone is the Schengen minimum of €30,000 under the Visa Code; for long-term residence, countries set their own, significantly stricter conditions, and this is where differences begin.
Two examples are illustrative. Spain for a non-lucrative visa requires full medical insurance from an insurer licensed in the country (DGSFP), with coverage at the level of the state system, without co-payments (sin copago), without waiting periods (sin carencias), and without a sum limit; a regular travel policy is not accepted here. The UAE made health insurance mandatory in all seven emirates from January 1, 2025—without it, a residence visa is not issued or renewed; in Dubai, the requirement has been in effect since 2016, the policy must cover a minimum of 150,000 dirhams per year, and a monthly fine is imposed for an uninsured family member.
Both examples point the same way: the requirement exists because the status itself does not yet open the public system, and the private policy stands in for the entitlement the state withholds. Access, where it comes, arrives with the status and on the status's own clock.
Under article 11(1) of Directive 2003/109/EC an EU long-term resident has equal treatment with nationals in social security, social assistance and social protection as defined by national law, subject to article 11(4), which lets a Member State confine that equal treatment to core benefits; article 4(1) opens the status itself only after five years of legal and continuous residence.
Even a status that does carry access can be charged for it: the United Kingdom levies an immigration health surcharge of £1,035 a year per adult and £776 a year per child under 18, paid up front for the whole period of leave. This page owns the policy and what it must cover, while the pattern of entitlements a status carries, and the clocks they run on, belong to What a Status Is Worth Beyond Entry: Tuition, Admission and a Child's Citizenship.
How much does it cost
The policy price is made up of several factors. The main one is the age of the insured: the rate grows fastest with years. Next come the coverage zone (the worldwide including US option is noticeably more expensive than worldwide excluding US because American healthcare sets the upper bar for expenses), the level of coverage (from basic inpatient to full outpatient treatment, dentistry, and maternity), and the size of the deductible.
The order of amounts is roughly as follows: basic international plans start from $1,500 per year per adult, full worldwide programs cost $3,000–$8,000 and above, and family policies cost proportionally more (figures are approximate and heavily depend on age and content). A deductible helps reduce the premium: the more expenses a person takes on, the cheaper the policy. Subscription products for nomads are cheaper than full IPMI, but their coverage is more modest, so they are separately checked against visa requirements.
Trends and outlook
The main market backdrop is medical inflation. According to WTW and Aon estimates, the global rate of medical cost growth in 2025 is around 10%, and double-digit growth is projected to continue in 2026; healthcare is becoming more expensive fastest in the Middle East, Africa, and Asia. For a policyholder, this means that the premium will grow year after year even without changes in conditions.
The products themselves are also changing: flexible insurance for digital nomads with monthly payments has appeared, telemedicine and mental health coverage are expanding, insurers more often offer direct settlements with clinics to spare the client from advances. For families with children and affluent clients, demand is growing for premium-level programs with access to the world's best clinics.
Programme by programme: what the policy must do
The requirement a policy has to meet is set by the programme, not by the insurer, and the programmes differ on more than the sum. Eleven common entry routes are set out below on the axes that decide whether a policy passes: the minimum cover, who may issue it, and whether the status later opens the public system and at what price.
| Programme | Minimum cover | Who may insure | Route into the public system | Price of public access |
|---|---|---|---|---|
| Schengen short-stay visa | €30,000; emergency care, hospital, repatriation | any insurer, valid across the Schengen area | none | — |
| Spain, non-lucrative residence | all risks covered by the public system | insurer authorised in Spain; an S1 registration also accepted | special agreement after one year of residence | €60 a month under 65, €157 from 65 |
| Portugal, D7 and D8 | valid travel insurance covering necessary medical expenses, urgent assistance and repatriation; recognised agreement-based cover may qualify for an exemption | check the applicable consular checklist; no uniform numerical limit is stated in the MNE general residence-visa checklist | SNS eligibility and complete registration; a user number alone does not establish payment coverage | depends on eligibility and the service |
| Italy, elective residence | private cover for the stay | — | voluntary enrolment in the SSN | at least €2,000 a year |
| Germany, any residence permit | "adequate" cover as part of secured subsistence | statutory fund or private insurer | statutory insurance through employment | income-related contribution |
| France, long-stay visitor | cover for the whole stay | — | PUMa after three months of stable residence | — |
| United Kingdom, work and family routes | no private minimum | — | NHS from arrival | surcharge £1,035 a year, £776 per child |
| UAE residence | Dubai: AED 150,000 annual limit; northern emirates: basic package since 1 January 2025 | employer buys for employees | none for expatriates | basic package AED 320 a year |
| Saudi Arabia, Premium Residency | at least the basic health-insurance benefits; emergency-only visitor or tourist policies are insufficient | insurer in the Kingdom; a qualifying existing employer policy may be accepted | this requirement concerns insurance for the holder and family, not automatic public-system entitlement | — |
| Thailand, LTR visa | USD 50,000 | any insurer; Thai social security or a USD 100,000 deposit instead | Thai social security if employed | — |
| Japan, digital nomad visa | ¥10 million | private insurer | none on this visa | — |
Four cells rest on primary texts read for this table. The Spanish consular requirement for the non-lucrative visa asks for public or private insurance "contracted with an insurance entity authorised to operate in Spain" covering all the risks insured by the public system, and accepts an S1 registration instead. Section 2(3) of the German Residence Act treats subsistence as secured only where it includes adequate health insurance cover without recourse to public funds, which makes insurance a condition of every residence title. Thailand's LTR programme asks for USD 50,000 of health cover, or Thai social security, or USD 100,000 kept on deposit for twelve months. Spain's special agreement, at €60 and €157 a month after a year of residence, comes from Royal Decree 576/2013, and Italy's €2,000 floor from article 1(240)–(241) of Law 213/2023.
The Portuguese MNE residence-visa checklist distinguishes travel insurance from recognised cover under international arrangements. It does not set a single numerical limit for all D7/D8 applicants; the consulate's applicable requirements still need checking. After arrival, Portugal's official SNS guide explains that a user number alone does not guarantee that the SNS pays the costs. Identification, tax number, a Portuguese address and a valid residence permit normally need to be linked to the record, subject to statutory exceptions.
For Saudi Premium Residency, the official health-insurance policy, sections 3.2–3.3 requires basic-benefit cover for the holder and family throughout the residence period. Visitor or tourist emergency-only cover does not qualify. A qualifying employer policy can be used while the holder remains employed in the Kingdom if at least six months of insurance remain when the residence is approved. Insurance must be maintained or renewed; the residence-law approval process also sets a 30-day deadline after notice of approval for the required fee and policy.
Five ways to hold cover
| Model | Moves with the family | Accepted by residence programmes | Pre-existing conditions | Evacuation and repatriation | What drives the price |
|---|---|---|---|---|---|
| International private medical insurance (Cigna, Bupa Global, Allianz Care, AXA, GeoBlue) | yes, across countries and zones | where the programme accepts a foreign insurer | underwritten; exclusion, moratorium or loading | usually built in | age, zone with or without the US, deductible |
| Local private policy | no, tied to one country's network | yes, often the only accepted form | underwritten, waiting periods common | often absent | age and local network |
| Nomad subscription | yes, month by month | rarely for residence | usually excluded | limited | age band and US option |
| Buy-in to the public system | no | it is the public system | no underwriting | none abroad | set by statute: special agreement, SSN contribution, surcharge |
| Employer group scheme | while employed | yes where the employer sponsors the permit | usually accepted on group terms | depends on the plan | paid by the employer |
What follows from the two tables
The programme decides the class of policy before the family decides anything. Spain and, in practice, the UAE require an insurer licensed or recognised in the country, which rules out a foreign international policy on its own however generous it is; Schengen, Thailand and Japan state a sum and leave the insurer open. A family that buys a global policy first and checks the programme second often ends up paying for two.
The second table shows what each model trades away. International cover follows the family across borders and keeps evacuation, but it is underwritten and priced by age and by whether the United States is in the zone. A local policy is cheaper and is often the only one a consulate accepts, but it stops at the border. A public buy-in has no underwriting at all, which is the decisive point for anyone with a pre-existing condition, and it is priced by statute rather than by risk.
The route into the public system is therefore part of the insurance plan. In Spain the private policy is a bridge of at least a year to the special agreement; in Italy an elective-residence holder pays at least €2,000 a year to join the SSN; in the United Kingdom the surcharge buys the NHS from arrival; in the UAE no public door opens to an expatriate at all, so private cover is permanent. Where the public door opens, an international policy narrows to evacuation and treatment abroad.
Profile against model
| Profile | Model that fits | Why |
|---|---|---|
| Retiree on a passive-income permit in southern Europe | local policy for the first year, then the public buy-in | the consulate wants a local insurer; the buy-in has no underwriting |
| Family moving every two to three years | international policy without the US zone | one contract across moves, evacuation included |
| Employee on a sponsored permit | employer group scheme, topped up if needed | the employer is obliged to insure in the UAE and pays contributions in Germany |
| Nomad on short stays | subscription product | cheap and monthly, but not for a residence application |
| Anyone with a pre-existing condition | public system as early as the status allows | private cover will exclude or load the condition |
Worked example: a retiree aged 66, public access in year two
A single retiree aged 66 moves on a passive-income permit and asks what access to the public system costs once the private-policy stage is over. In Spain the special agreement costs €157 a month, €1,884 a year, after one year of residence. In Italy voluntary enrolment in the SSN costs at least €2,000 a year. In Portugal, SNS payment coverage depends on eligibility and complete registration; a user number alone is not enough, and charges depend on the service. In the United Kingdom there is no passive-income route to price, and the surcharge applies to the work and family routes at £1,035 a year. Against those figures, a basic international plan starts at around $1,500 a year for an adult and rises steeply with age, so for a retiree the public buy-in is usually the cheaper and, because it does not underwrite, the more reliable long-term cover.
Q/A
How does international health insurance differ from travel insurance?
Travel insurance is designed mainly for unexpected incidents during a short trip. International health insurance commonly covers planned and inpatient care during long-term residence, but the policy wording defines the actual scope. For immigration purposes, the product label matters less than compliance with the authority’s stated requirements.
How can I check whether a policy qualifies for a visa or residence permit?
Compare the programme’s official rules on duration, territory, benefits, limits, deductibles and authorised insurer status, then obtain a named certificate and proof of payment. A broker’s generic letter may not suffice: some routes require a full year of cover and expressly reject ordinary travel insurance.
Are pre-existing conditions covered automatically?
No. The insurer may medically underwrite the application, exclude a condition, impose a waiting period or apply a moratorium; treatment varies by product and country. Disclosures on the application should be complete because omissions can affect claims. A written underwriting decision is more reliable than an intermediary’s oral assurance.
Are medical evacuation and repatriation the same benefit?
No. Medical evacuation usually means transport to the nearest suitable medical facility when local care is inadequate. Medical repatriation means returning the patient to the country of residence or nationality when the patient’s condition and the policy permit it. Either benefit may be optional and subject to separate pre-authorisation rules.
What should I review besides the headline coverage limit?
Check the territorial scope, inclusion or exclusion of the United States, provider network, direct billing, pre-authorisation, deductibles, co-payments, benefit sublimits, medicines, mental health, maternity, evacuation and repatriation. Renewal rules and the effect of moving to another country also matter.
Will an international policy be accepted for a residence permit?
Only where the programme leaves the insurer open. Schengen, Thailand's LTR visa and Japan's digital nomad visa state a sum and a scope, so an international policy that meets them passes. Spain's non-lucrative visa requires an insurer authorised to operate in Spain, covering all the risks of the public system, so a foreign international policy does not qualify on its own; the UAE ties residence to cover bought from the local market by the employer or sponsor. The programme's own list is checked before the policy is bought.
When can a resident switch from a private policy to the public system?
It depends on the status and the country. Workers enter through employment almost everywhere; for others, France opens PUMa after three months of stable residence, Portugal provides SNS coverage subject to eligibility and complete registration rather than the user number alone, Spain the special agreement after a year at €60 or €157 a month, and Italy voluntary SSN enrolment at a minimum of €2,000 a year. The United Kingdom charges the surcharge up front instead, and the UAE offers expatriates no public entry at all.