essential reading for travel insurance ......essential reading for travel insurance industry...

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK APRIL 2012 • ISSUE 135

INSIDE

NEWS & APPOINTMENTS page 6

New research by American Express Global Business Travel has served to outline gaps and opportunities that companies need to address to strengthen their managed travel programmes by focusing on travel and expense policies. Mandy Aitchison reports

Analysing nearly 100 travel policies of global, multinational, and mid-sized companies, American Express Global Business Travel’s research shows that less than one third of these companies overall have updated their travel policies within the last year. This oversight can leave companies exposed to losing hard-earned corporate negotiated rates, and more importantly, may put travellers at unnecessary risk, said American Express.“It’s a new year and with any good business practice, corporate travel departments are setting goals, including bringing their programmes in line with the competition and external marketplace dynamics,” said Christa Degnan Manning, director of EXPERT INSIGHTS research, American Express Global Business Travel. “However, like many improvement resolutions, reviewing and revising a travel policy tends to get neglected. Yet a healthy travel policy can help companies achieve long-term success. Policies can support business-critical goals such as risk mitigation and employee engagement, as they touch on issues from traveller safety and security to

corporate social responsibility.”Items in the report highlighted by American Express included the revelation that only 12 per cent of companies addressed traveller security, even though it is a critical issue for companies to consider as more employees are sent to work abroad. Eighty per cent of those surveyed did not address reimbursement on ancillary fees such as checked bags, reservation change fees, or other for-purchase services offered at hotels and car rentals. Furthermore, only 35 per cent of smaller companies and large international organisations require an agency to book hotels, compared to 85 per cent of global companies.Another fi nding of the report was that none of the travel policies addressed the use of mobile phone applications or even referenced tools they may have available for travellers to use on the road or when working remotely. Companies are also neglecting their bottom line, according to the survey, which shows that 70 per cent of companies do not provide specifi c guidelines to travellers on when it makes sense to book airfares through a non-preferred supplier if the ticket price is less expensive.“Policy is the foundation of a successful managed travel programme, and maintaining this infrastructure by conducting regular check-ups is paramount,” said Helen Brough, advisory services global policy practice director, American Express Global Business

Travel. “In our policy practice we have identifi ed over 300 areas companies should be reviewing in their policy for the best outcomes – for the company, for the travelling employees, and for ultimate travel management programme success. Companies that are most successful are those that regularly review and update their travel policies based on changing market conditions as well as focus on communicating those policies to their travellers.” The fi rm then makes a series of recommendations to companies of the ways in which the problems listed above can be rectifi ed, which include companies offering guidance to their travellers for the range of areas associated with security.Brough continued: “It is not enough to just develop a travel policy and assume that employees know what to do with it. Companies should be actively leveraging and communicating their travel policy to employees and enlisting infl uencers within the company such as human resources, security and legal to support these efforts. In terms of making business travellers connect more with their company’s travel policies, American Express recommends that fi rms make the policy accessible and appealing to the traveller, as well as revisiting the policy often to ensure relevancy, and eliminating uncertainty by making the wording as clear as possible to ensure that travellers understand the benefi ts and limits of the policy.

Corporate cover concerns

Claims reveal injury statisticsUK-based online comparison site Cheap.co.uk has announced that data in ski claims has shown young, female snowboarders are the most likely to suffer injuries on the ski slopes. Sarah Watson has the details

A spokesman commented: “Our claims information has shown snowboarders are hurt more often than skiers, with young females the most likely to cause themselves an injury. We still see a signifi cantly higher number of medical claims from skiers, but this is to be expected as more travellers currently enjoy this activity. Our data has shown that the percentage of snowboarders at a resort is lower at around 18 per cent than the percentage of snowboarding-related claims, which comes in at around 22 per cent. It has been this way for a number of years now.” Snowboarders are most likely to suffer from wrist or shoulder injuries and Cheap.co.uk found many injuries were a result of falling forward on snow with wrist sprains, wrist breaks, fractured collar bones and concussions topping the claims information.Skiers suffered highly from torn knee ligaments, leg muscle bruises and other knee-related injuries. The company continued: “The less experienced who are learning a new sport or activity are always the most at risk. Both skiing and snowboarding is an extreme sport and the risks can be extremely high, so the data is not surprising in any way. But it’s the risks that make the sport more appealing and interesting.”Specialist travel law fi rm in the UK Irwin Mitchell is also urging caution on the slopes. Demetrius Danas, a specialist in skiing and snowboarding accidents at Irwin Mitchell, said: “We’re still seeing clients coming to us with serious injuries caused by a lack of safety barriers, inadequate marking of ski pistes, insecure chair lifts or collisions with other skiers or snowboarders who haven’t had suffi cient training.”

International Travel Insurance Journal

2 NEWS

REGULARS

News continued 4

Editorial rant 4

Company brief 10

Insurance matters 12

Health matters 16

Travel matters 18

IPMI news 20

Air ambulance news 22

Service directory 43

Grapevine 50

On the move 51

NEWS ANALYSIS

After the judgement 8ITIJ questions the implications of the UK’s High Court not allowing a judicial review of an ash cloud-related travel insurance dispute

FEATURES

Cruising for a bruising 26As cruise ships get ever larger and embark on ever more ambitious itineraries to more distant seas, what are the implications for medical assistance companies?

ITIC Review: New Orleans 28A summary of all the presentations that were made during ITIC New Orleans

Assistance & Healthcare World Markets:Turkey 38The continuing popularity of Turkey as a holiday destination has placed the focus squarely on the provision of medical assistance and clinics in the country

IN THIS ISSUE ITIJ CONTRIBUTORS

Published on behalf of: Voyageur Publishing & Events Ltd, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or fi rm mentioned is hereby excluded. The views expressed do not necessarily refl ect those of the publisher.

Printed by Pensord Press, South Wales, United Kingdom

Copyright © Voyageur Publishing 2012. Materials in this publication may not be reproduced in any form without permission

INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522

Would you like to make a comment?Please get in touch with Ian Cameron,

Editor-in-Chief of ITIJ on +44 (0)117 922 6600 ext205

Editor-in-chief: Ian Cameron

Editor: Sarah Watson

Title editor: Mandy Aitchison

Copy editor: James Paul Wallis

Conference manager: Denise Clements

Production: Kirsty DiclaudioHelen Watts

Subscriptions: Kate Knowles

Advertising sales: David Fitzpatrick James Miller

Finance: Elspeth ReidLouise Goddard

Design: V Creative Design vcreativedesign.co.uk

ITIJVoyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK

Telephone: +44 (0)117 922 6600editorial dept: Ext. 3advertising dept: Ext. 1subscriptions dept: Ext. 209accounts dept: Ext. 4

fax: +44 (0)117 929 2023email: [email protected] web: www.itij.co.uk

WOULD YOU LIKE TO SUBSCRIBE? VISIT www.itij.co.uk/subscription

ITIJ TEAM

Robin Gauldie has been a freelance journalist since 1989, writing for the travel sections of national newspapers including The Sunday Telegraph, The Observer, The Times, The Sunday Mirror, The Guardian and Scotland on Sunday. He is the author of more than 20 travel guidebooks to destinations including Greece, Scotland, France, Portugal, Egypt and Morocco.


4 NEWS

Global airline Air France has changed its oxygen cylinder rules and costs, which could mean increased expenses for assistance companies and their partner insurers wishing

to repatriate a customer

on a

commercial airline. Under the new rules, if a passenger needs more than two litres of oxygen for the duration of the flight, it is now required that they be put on a stretcher – at a vastly increased cost than a business class seat with an oxygen cylinder by the side of the patient.Marc Lucas, director of Voyageur Travel in the UK, said: “This move by Air France is likely to cost insurers thousands of pounds more for a repatriation flight – the difference in cost that having a stretcher onboard a commercial aircraft versus a business class or even first-class seat is significant.”In related news, Spanish airline Iberia has reportedly stopped offering stretcher services to customers flying on domestic and short-haul flights. The company told Voyageur Travel that it will continue to offer stretcher services on long-haul flights.

Ian [email protected]

This month’s rant comes live to you from the ITIC Americas conference in New Orleans. A fun city for a conference provided you’re not worried about hurricanes and dykes (that’s levies to you Philistines ... the things that hold back the water ... not women in comfortable shoes ... sometimes I do despair of you, dear reader!)

Anyway, what’s new outside of this great conference? Well I was tickled by the statistics on page one about skiing injuries, noting that you are more likely to be injured if you’re a young woman enjoying snowboarding, with wrist breaks and sprains, fractured collar bones and minor head injuries topping the popularity list.

This comes with a particular significance to me personally, as the banker ... sorry ... father of two of that particular category of the species ... young, female, snowboarders.

Not wishing to quibble with what are undoubtedly well-documented statistics, but I find the statistics troubling (in the young female category) and would make the following observations:

a) In the unlikely event that they make it onto the slippery slope after a night clubbing etc. the one token run is taken at speeds not exceeding 2mph (didn’t I teach them well!!)

b) Wrist sprains can usually be attributed to excessive texting while on the piste, while the wrist and shoulder breaks tend to be on the non texting hand which is used to break the fall (while texting ... I’m convinced that if the statue of the Venus de Milo were sculptured today, she would be holding a mobile phone)

c) Head injuries result mainly from panic at not being able to switch from texting to answering a call in rapid enough time. The phone is propelled upward towards the ear and sometimes the ice makes it slip, a bit like throwing a hammer at your own head.

So anyway ... claim denied ... injuries all self-inflicted in my book.

With humble apologies for the blatant sexism in this column.

A small problemIn a survey commissioned by UK-based AllClear Travel Insurance, it was found that some 40 per cent of travellers never read, or at best skim read, the small print in their travel insurance policies, despite every effort from the industry to encourage consumers to do so. A further 26 per cent of respondents to the survey admitted that they merely skip to a particular section of interest or relevance, which Mike Rutherford, chairman of the insurer, said risked them missing something vital about their coverage. He added: “These figures reflect a widespread ‘tickbox’ attitude towards insurance that greatly concerns me. Although most travellers understand the need to have insurance, a large number appear to buy ‘blind’ and trust to luck if something goes wrong.”AllClear’s survey took in over 2,000 UK adults to ask them about their travel insurance habits, and the results showed that almost one in 10 confessed to never reading any of the small print of their policy. Rutherford said: “Admittedly, as an industry we do not help ourselves by making the small print so onerous to read and confusing in its presentation. Insurers need to do more to make policy wording accessible to the people who buy it.” A statement the UK Financial Ombudsman Service would no doubt agree with wholeheartedly. Rutherford further added: “However, incoming government legislation that will oblige banks and credit companies to be more explicit about whether a particular policy makes provision for medical cover should be good news for travellers, and will help to make the small print more transparent, so that [customers] know exactly what [they are] getting with [their] policy.”

Many older British travellers are likely to travel without insurance or not travel at all this summer, as they see annual increases of up to 90 per cent on the cost of their travel insurance. This widely held belief has been confirmed by online provider Cheap.co.uk, which is seeing insurance costs increasing in line with competitors.This rise has been blamed mainly on increases in the cost of medical care in various countries, including the US and several European countries. Pensioners who plan to visit the US are being hit particularly hard should they have a pre-

existing medical condition.

Increased travel insurance fees could heavily increase the costs of holidays and with many pushing their finances further, pensioners with a medical condition will need to decide whether to pay the additional fee or travel without cover and accept the risks this brings.A cheap.co.uk spokesman confirmed: “Prices have risen this year due to the increase in underwriting costs. It’s not just the actual medical costs themselves, there’s also the currency rates and aviation fuel costs to take into account.”On 1 April, any provider unwilling to quote for a traveller due to their age must offer them an alternative provider who will do so, when the government’s agreed signposting system comes into play in the UK.

Underwriting blamed for cost increase

Annual cover urgedAccording to UK price comparison website comparethemarket.com, this is the peak time for consumers going online to seek the best deals for this year’s travel, including their insurance. With an extra bank holiday on the UK working calendar due to the Queen’s Diamond Jubilee, people may take advantage of the additional time and take another holiday break. For those considering more than one trip this year, comparethemarket.com has urged consumers to consider buying annual multi-trip policies, which it says help people save in the long term by insuring the policyholder for multiple short duration trips during the 12-month period.Andrew Stocks, director at comparethemarket.com said: “Annual travel insurance gives holidaymakers that extra peace of mind. The range of policies on comparethemarket.com also provides the option to cover winter sports, business trips, cruises and backpacking.” He added: “Finding the right travel insurance policy is easy with [our] simple comparison service. We offer a quick and easy way to view some of the best deals for travel insurance, including annual and single trip cover. Our service brings together a range of policies at affordable prices from reliable household brands.”

Top providers namedTravel Insured International, which was the top selling travel insurance provider for the year of 2011 and also January 2012, maintained the top spot in February with almost 20 per cent of the overall market according to Squaremouth.com, a US travel insurance comparison site. “Travel Insured International continues to be one of our top providers because they cater well to the senior market, a large purchaser of travel insurance,” says Squaremouth CEO, Chris Harvey.In addition to offering competitive senior pricing, Squaremouth attributes Travel Insured International’s continued high sales to their ‘kids go free’ polices. Their Worldwide Trip Protector policy allows all children to be insured for free when travelling with a parent.Since Squaremouth does not target specific demographics or promote individual providers, it said these statistics represent an unbiased overview of the travel insurance market. “As a comparison site, we work hard with providers to present standardised policy information,” said Harvey. “This levels the playing field by providing a pure marketplace. If a product has a great benefit or feature, our platform allows it to shine against its competition.”When customers compare travel insurance on Squaremouth’s website, policies can be viewed side-by-side in order to highlight benefit limits, such as the amount of emergency medical, trip cancellation and evacuation benefits. “Travel insurance is not a ‘one-size-fits-all’ product,” added Harvey. “The best selling travel insurance provider normally captures about 20 per cent of policy sales, which means 80 per cent of the time other providers offer more well suited policies.”

Stretcher changes at Air France and Iberia

www.itij.co.uk

NEWS 5

From 1 March, any traveller from Malaysia who books a holiday through an agent that is part of the Malaysian Association of Tour and Travel Agents (MATTA) has to purchase travel insurance. Under the new scheme, travellers can choose from 20 areas of cover, eight of which are considered to be critical – medical/hospitalisation costs, emergency medical evacuation, reimbursement of deposits or full payment of air tickets or tour packages, repatriation of mortal remains, compassionate visitation benefits, accidental death, permanent disablement and a 24-emergency call centre.

The eight critical covers above are the result of market experience, which has shown which are the most important areas for insurance to cover. Mohd Khalid, president of MATTA, said that the organisation had received ‘numerous complaints’ from the travelling public, who faced trouble trying to get the finances together to pay for the repatriation of mortal remains of loved ones who have died abroad. He added: “This can go a long way for those who struggle to settle the high cost of medical bills while on holiday overseas, or for lost luggage and travel delays.”Khalid also noted that MATTA has pushed forward the mandatory travel insurance issue in part due to the high number of cases seen where travel agents have gone bankrupt or absconded with money

that potential holidaymakers have paid, and that the insurance would cover such a situation. Travel agents that are part of MATTA but do not sell the insurance will be referred to the Tourism Ministry.Not everyone believes that making travel insurance mandatory from travel agents is the best option for the public though. President of the Federation of Malaysian Consumers N. Marimuthu told local newspaper The Malay Mail that the public needs choices: “While is it is a good idea to offer travellers such insurance packages, consumers should be allowed to decide if the insurance offered suited them. The terms and conditions of the insurance should be clear and must benefit customers. Consumers must also see for themselves if their

personal credit card facilities meet their expectations in terms of coverage.”Dr Jacob George, president of the Consumers’ Association of Subang and Shah Alam, echoed concerns about travel insurance provided by credit cards duplicating the cover on offer from travel agents, saying that the public should be wary of spending money where it is not needed: “Most credit cards would cover travel insurance, and it is important to make sure they are not charged extra.”ITIJ would urge caution with credit card cover as well though – often the small print puts strict limits on the amount that a policyholder can claim, and these limits tend to be more generous with stand-alone travel cover.

Essential covers claimsUK-based Essential Travel has revealed some of the claims it has dealt with from UK holidaymakers, which show quite how much money even the simplest travel problem can cost, and the value of having travel cover in place. The company saw a medical expenses bill of £23,000 for a bad bout of Delhi Belly that would have been more than a pain in the bum for one unlucky traveller had he not invested in insurance. Another claim came from a poor gent struck by lightening in South Africa, the treatment for which saw medical costs of over £5,000. Essential Travel continued: “Who said Americans are greedy? It was a Brit caught gobbling down his steak. Luckily he won’t be choking on his medical bill of over £5,000 as his insurance meant that he didn’t bite off more than he could chew. They say local grappa tastes like rocket fuel, but one traveller in Turkey took that a bit too literally when they accidentally drank gasoline resulting in a hangover to the tune of over a £1,000.”A real life slip of the tongue almost ended in disaster in Turkey when one lady ‘swallowed her tongue’ after an almighty sneeze. The £1,000 bill covered by her insurance wasn’t to be sniffed at. A plucky young traveller in Mexico suffering from chicken pox managed to rack up a bill of £20,400 in medical fees. Getting a suntan is one thing, but oiling up a medical bill for £2,550 to treat sunburn in the US would certainly have left one traveller with scars if insurance hadn’t covered the cost. Having insurance certainly took the sting out of the £4,800 medical bill one gent in the Dominican Republic suffered after receiving a nasty insect bite, while another traveller in Indonesia saved himself a medical bill of over £1,000 for a monkey bite. The bill could have been worse than the bite for the individual suffering from a nasty dog attack in South Africa, which didn’t set him back the £6,000 it cost to get him fixed up as he’d invested in travel insurance.Stuart Bensusan from Essential Travel said: “I think many people looking at some of our highest claim costs – and some of the reasons for them – will be extremely surprised. Some of the cases may raise a smile, but there’s a serious side too. In addition to the £23,000 Delhi Belly case mentioned above, we’ve also seen payouts of £89,359 on bleeding lesions, £69,699 spent on cellulitis in Canada and £59,135 on a back injury in the US. These were serious medical conditions not just requiring financial help, but also the support and logistical assistance that our insurance provided for.”

Malaysian mandatory cover in the spotlight


6 NEWS

Which? wish listResearch by Which?, a UK consumer organisation, has criticised the way that some travel websites will automatically opt customers in for certain extras. “Often,” says the research, “these were for insurance, but other examples included an expensive automatic upgrade on a flight, seven days’ car hire, and airport lounge access for a short-haul flight.” Which? wants to see such practices by the travel industry stopped. For each company surveyed by the group, a user went through the booking process from start to finish to see if any extras were automatically added onto the final price.Some of the opt-in problems cited by Which? appear to be particularly odd and would seem to be quite poor customer service. One website, for instance, when a customer was booking a cruise departing from Miami, opted said customer in for an ESTA – the visa Britons need to visit the US – at a cost of £27 per passenger. If someone were to go online and sort their own ESTA out, though, from the US Customs and Border Agency, it would cost just £9 per person.Which? research found that insurance was automatically added to customers’ bills by several websites, including Saga, the specialist over-50s holiday provider, Shearings Holidays and hotel chain Travelodge.In related news, Which? Travel has announced that it has written to the Association of British Insurers to ask the organisation to follow up on concerns that it raised in an article about travel insurers using ‘get out’ clauses to swerve claims related to medical conditions. Which? said: “We want insurers to stop relying on a rigid scoring system to assess customers’ health. Instead, they should pay more attention to individuals’ specific circumstances and the advice of their doctors if their medical condition changes after buying a policy.”

NEWSWIREFour tourists and a further four locals have died in the waters around the Cayman Islands so far this year, prompting a warning from authorities about the potential dangers lurking in the sea.

A Canadian tourist died in March on the Caribbean island of Dominica, after she went snorkelling on a shore-based excursion from her cruise holiday. The 61-year-old was with friends when she is said to have started struggling in the water before collapsing back on shore.

Air Zimbabwe has suspended all flights indefinitely, after workers who had not been paid since July 2011 refused to turn up for work. Acting chief executive Innocent Mavhunga confirmed that the company has serious cash flow problems relating to payment of salaries.

Abigail Comber, head of marketing at British Airways, has urged holidaymakers to check their travel insurance before they travel so that they know exactly what they are covered for before they leave home.

Around 30 foreign tourists were hospitalised in Phuket in February after they were exposed to dangerously high levels of chlorine in their hotel resort pool. The chlorine caused skin irritation and sore eyes, although one pregnant tourist reportedly also suffered breathing difficulties after inhaling the chemical.

A Russian woman was killed and dozens of other foreigners injured when their tour bus swerved and flipped onto its side in rural Cambodia. The driver, who police believe caused the crash by driving too quickly, fled the scene of the accident.

A Canadian woman who was onboard a Celebration Cruise Line ship disappeared at sea between Palm Beach, Florida, and the Bahamas. An extensive search of the ship was unsuccessful, but prompted an FBI investigation and an extensive US Coastguard search.

Two Russians, a Turk and a Ukrainian citizen were killed in Phuket, Thailand, in a multiple vehicle accident. Five more tourists were taken to hospital after the accident, three of whom were in a critical condition. The tourists were all in a minivan that had taken them for a day trip; the driver reportedly fled the scene.

Mondial Assistance has been placed at 58 in the most recent Sunday Times list of the ‘Best 100 companies to work for’, and has also achieved an ‘Outstanding’ rating with a two-star accreditation from workplace engagement specialist Best Companies.

Cruising doesn’t appear to be losing its popularity, despite high-profile incidents from the Costa Crociere cruise line involving its Costa Concordia and Costa Allegra vessels. Squaremouth, a US-based travel insurance comparison site, has aimed to help cruising customers find the most appropriate insurance for their needs, and in the process is going against some of the more commonly-held beliefs about coverage levels.Sarah Byrne, marketing manager for Squaremouth, said: “Many travellers fall into the trap of assuming they understand their policy’s coverage before thoroughly reading the certificate. This can lead to travellers thinking they are covered for situations the policy doesn’t actually cover.”

The first myth that Squaremouth claims to have busted is that customers need at least $1 million in medical evacuation coverage. Chris Harvey, chief executive of the website, disagrees: “Some policies offer several million dollars of evacuation coverage. However, it is rare for an evacuation to cost more than $100,000. Don’t spend more for a policy thinking multi-million dollar coverage is necessary.” The website recommends that customers choose the amount of medical evacuation coverage based on their destination and

type of trip. “For example,” it states. “$100,000 in evacuation coverage should be enough protection for a cruise to the Caribbean, however, travellers visiting Asia or Africa may want to consider a travel insurance policy with at least $250,000 in evacuation coverage.”Myth two that Squaremouth aims to dispel is that

the insurance provider would come and rescue their client from the cruise. Said Harvey: “Most people mistakenly believe medical evacuation coverage is a form of search and rescue, plucking injured hikers off of mountainsides or heart attack victims off cruise ships at sea.”The third myth, widely believed, is that medical evacuation insurance will cover the cost of medical treatment. The firm points out that although medical evacuation covers transportation to the nearest medical facility, or moving an injured client from one hospital to another for more appropriate care, the actual cost of the treatment is separate.Myth four, according to Squaremouth, is that some customers believe they can choose the destination to which they will be evacuated. The site cautions that this is true ‘only to a degree’, adding the following warning: “The emergency assistance team will expect to be involved in all major medical and logistical decisions, including where the treatment occurs. If specialised care or transport to another facility is needed, there are three parties involved in the decision: the insurance company, the treating physician and the policyholder.” There are travel policies on sale that have a ‘Hospital of Choice’ option, although this is usually an upgrade to a policy.The final myth that Squaremouth wishes to bust is that having travel insurance means that the medical treatment cost will be paid up front by the insurance provider. Suzanne Munson, marketing manager at travel insurance provider Seven Corners, warned the public: “Many travel insurance providers have the ability to arrange payment with medical providers overseas, but it is the treating facility’s decision as to whether or not they wish to work with you. Be prepared to pay for your medical care upfront, and file a claim for reimbursement.”

Weather worriesA recent Travel Beat survey carried out on behalf of Travel Guard North America found that travellers are most concerned about weather-related delays and cancellations affecting their travel plans.For 42 per cent of survey respondents, worries about the weather causing problems with air travel was the most significant concern they have. Twenty-one per cent of travellers said they also held concerns that an unforeseen event might disrupt plans, while 15 per cent cited concerns about cancelling a trip due to a personal problem. It seems people aren’t as interested in their precious possessions as one might think, though, with just one per cent of people saying they were concerned about lost luggage.The good news is that all of these concerns together have led to 93 per cent of survey respondents purchasing travel insurance.

UAE enjoys market growthHussein Al Meeza, chief executive officer and managing director of Dubai Islamic Insurance and Reinsurance Company (Aman Insurance), has said that the travel insurance market in the United Arab Emirates is poised to grow by 40 per cent in 2012, backed by an active tourism market. In order to ensure that outbound tourists are comprehensively covered, the company has recently launched three new products that have been designed to cater to the high-end market. Al Meeza told Trade Arabia: “One of the main reasons for this continued growth is the recent development of making travel insurance a compulsory aspect of securing a travel visa to any desired country, particularly Shengen and other European countries.”

International students get specific coverTapan Singhel, chief marketing officer for Bajaj Allianz General Insurance, has been discussing a new trend in the Indian travel insurance market whereby students heading overseas to study are reaping the benefits of travel insurance that has been designed specifically for their needs. With the number of Indian students going abroad to study increasing all the time, and with a number of universities in the US insisting on health cover being in place before they get there, the opportunity for growth in the market in undeniable.Singhel said: “[These] products cover all health and travel-related risks while the student is in a foreign country. It also provides additional cover for family visits, accidents and tuition fee [cover], which is not available in other standard travel products.” He added: “These plans are available for one or two years, but can be extended on requesting the insurer and providing a certificate of good health. The plan also helps in semester tuition fees reimbursement, subject to a maximum limit … in case the insured is unable to continue the school semester due to a serious medical condition of the insured requiring hospitalisation or death/serious injury requiring hospitalisation of either of the parents during the policy period.”

Myths busted by Squaremouth

GESTITURSA c/Marina, 16-18, 5ª planta. Mod. D. Torre Mapfre, 08035 Barcelona (Spain)Tel. +34 93 224 74 99servicios.juridicos@gestitursa.eswww.gestitursa.eswww.fundaciongestitursa.org

NEWSWIREFour tourists and a further four locals have died in the waters around the Cayman Islands so far this year, prompting a warning from authorities about the potential dangers lurking in the sea.

A Canadian tourist died in March on the Caribbean island of Dominica, after she went snorkelling on a shore-based excursion from her cruise holiday. The 61-year-old was with friends when she is said to have started struggling in the water before collapsing back on shore.

Air Zimbabwe has suspended all flights indefinitely, after workers who had not been paid since July 2011 refused to turn up for work. Acting chief executive Innocent Mavhunga confirmed that the company has serious cash flow problems relating to payment of salaries.

Abigail Comber, head of marketing at British Airways, has urged holidaymakers to check their travel insurance before they travel so that they know exactly what they are covered for before they leave home.

Around 30 foreign tourists were hospitalised in Phuket in February after they were exposed to dangerously high levels of chlorine in their hotel resort pool. The chlorine caused skin irritation and sore eyes, although one pregnant tourist reportedly also suffered breathing difficulties after inhaling the chemical.

A Russian woman was killed and dozens of other foreigners injured when their tour bus swerved and flipped onto its side in rural Cambodia. The driver, who police believe caused the crash by driving too quickly, fled the scene of the accident.

A Canadian woman who was onboard a Celebration Cruise Line ship disappeared at sea between Palm Beach, Florida, and the Bahamas. An extensive search of the ship was unsuccessful, but prompted an FBI investigation and an extensive US Coastguard search.

Two Russians, a Turk and a Ukrainian citizen were killed in Phuket, Thailand, in a multiple vehicle accident. Five more tourists were taken to hospital after the accident, three of whom were in a critical condition. The tourists were all in a minivan that had taken them for a day trip; the driver reportedly fled the scene.

Mondial Assistance has been placed at 58 in the most recent Sunday Times list of the ‘Best 100 companies to work for’, and has also achieved an ‘Outstanding’ rating with a two-star accreditation from workplace engagement specialist Best Companies.

The crisis affecting member countries of the European Union is driving many of them to take severe austerity measures to an extent previously unimagined. In many cases they are not differentiating clearly between superfluous costs and those that bring a collateral, significant reduction in quality of care. Surprisingly, at the same time, health administrations that have seen draconian cuts in resources for care have taken hardly any measures to reduce the real dead weight: out of date and inefficient internal management systems.

Third Party Obliged To PayThe lax way that the health administrations manage the recovery of payments from private patients for the Spanish Public Health System (SPE), the billing of third parties obliged to pay and the follow-up of these has reached such an extent that it has led to the false belief that in Spain, health care is always paid for with public money. This belief, touted as “indisputable” by commercial interests, neither reflects the wording or the spirit of the regulation. This clearly states who should cover medical expenses and in which cases. The cornerstone of the SPE (General Law of Social Security and Law 14/1986 of 25 April, General Health Law) is the principle of free care for the user who can demonstrate his coverage by the public healthcare system, but it does not state that medical costs should always be paid by public funds. On the contrary, since 1986 (Article 83 of the General Law of Health and concordant regulation) the law states that the state should only cover the cost of medical care administered to a patient when there is no third party obliged to pay.

Public Health Spending in Spain in Relation to Tourism: Regulation ApplicableTourism adds a new variable to the capacity of the SPE to continue providing services. Some of the tourists who travel to Spain will require medical treatment from the Spanish public health system. However, unlike the Spanish, most tourists arrive with a travel insurance policy with covers emergency medical attention. That is to say, in most cases a third

party obliged to pay does indeed exist.The possibility of billing tourists in Spain for medical services is based on the principle of equal treatment (Rule Nº 883/2004 of 29 April and Spanish internal rules) and also, on the inexistence of the right to obtain free medical treatment. The principle of equality of treatment includes the right of any foreigner to be attended by the SPE under the same conditions as Spanish nationals. In consequence, the SPE can claim the payment for the services supplied to a foreigner to a third party obliged to pay, either by law or contract, if this exists.Tourists from countries outside the EU, without detriment to existing bilateral agreements, are private patients for the SPE, therefore, if they don’t have a private medical policy they should pay the cost of services received personally. On the other hand, patients covered by the TSE (European Health Card) normally carry private insurance policies for medical emergencies.

Thus, as a third party with obligation to pay exists in the case of tourists, excluding free services due to the patient, there is a requirement to claim back the cost of services provided to the tourist who is simultaneously an SPE patient and client of an insurance company.Despite this, there has been a widespread interpretation of the rule that assumes that the SPE should cover costs when a patient carries a TSE. This interpretation is the root of unfair practices by certain companies, who with the coverage of the TSE claim that the costs of their clients should be covered exclusively by the SPE. However, these practices are defrauding the insured, who on one hand pays for services so that the company will cover the costs, while the company tries to pass

the cost to the SPE, an activity described in jurisprudence as “making unfair gains”

ConclusionThe provision of medical attention for foreigners is governed by the principle of equal treatment, understood as the right of the foreigner to receive treatment, by law, the same as a Spanish national. Therefore, anybody insured by either the Spanish, or a foreign public health system, who carries a valid TSE, has the right to receive health care without having to pay for it directly. On the other hand, a foreigner not covered by the TSE is private patient in the public health system and should pay unless they have a private health insurance.However, this does not mean that payment of costs and fees should always be paid by the state, but that the SPE can claim these costs back from third parties obliged to pay in the case that they exist. Therefore, such costs are only accepted by the SPE when there is evidence of public insurance and no other third party is obliged to pay. Similarly, if third parties obliged to pay did not take responsibility for costs due to them legally or contractually, the travel insurances contracted would be rendered of nil content despite the client continuing to pay the contracted quota, as they would be receiving no real service in exchange.Independently of the above, the fact that the TSE and the CPE contain personal data prohibits their use by unauthorized parties. Thus non authorized parties cannot send copies of the TSE or the CPE without infringing the Spanish

law of data protection, which prohibits use of data without the express permission of the subject.Finally, the TSE should be presented before a patient is discharged, as the Spanish public health system must know if it must accept the costs, claim them back from a third party obliged to pay or bill the patient directly.

European Crisis Takes Hold

ADVERTISEMENT

Dr. José Domingo Valls LloretHead of Legal Services DivisionLawyer and Doctor of LawProfessor of Civil Law at University of Barcelona (Spain)


8 NEWSANALYSIS

In March 2011, the UK’s Financial Ombudsman Service (FOS) decided that the 2010 ash clouds that hovered over Europe from an Icelandic volcano, causing weeks of travel disruption, constituted a weather event. Some travel insurers disagreed, and Europ Assistance asked for a judicial review of this decision. In February, the High Court refused the company’s request. Here, Daniel Scognamiglio and Chris Deacon examine the judicial review process and look at the latest EU Opinion on airlines’ duty of care to passengers caught up in situations such as that posed by the ash clouds

From 14 April 2010, volcano Eyjafjallajökull erupted for six days, billowing plumes of smoke that floated across large parts of northern Europe. In an unprecedented move, around 20 countries were forced to close their airspace, affecting hundreds of thousands of flights and an estimated 10 million travellers. To provide travel insurers with a framework for denying or allowing claims, the UK’s FOS declared in March 2011 that this eruption constituted a ‘weather event’. Not all travel insurers agreed. However, there was some hope, in May 2011, that the FOS decision would be referred to an English Court for review, following a request by Europ Assistance (EA) for a test case. The FOS can dismiss a complaint where it raises an important or novel point of law that has significant consequences and would be more suitably dealt with by a court as a test case. However, although EA made a strong case for the hearing, the ombudsman did not agree that the matter should be heard by a court. As far as we are aware, the FOS has yet to decline to reach a decision on a travel insurance matter due it being novel or important.Although the FOS’s decision is not a general legal ruling, the ombudsman who refused to refer the Europ Assistance matter as a test case, Caroline Mitchell, said it would be fair if, at that point, the insurer treated the ash cloud as weather. However, the insurer argued that under the reasoning of the ombudsman, insurers would have to list every single potential event that is not covered by the policy, and it appealed to the High Court for a judicial review of the FOS’s decision, which was recently denied. Furthermore, on 23 March 2012, the European Court of Justice Advocate General gave his opinion on airlines’ liability in the context of Ryanair’s treatment of one particular passenger during the ash-cloud crisis. We’ll look at this in more detail, but for now, let’s look at the judicial review process.

Judicial reviewHaving received an unfavourable final decision from the FOS and any appeal having been declined, insurers have one option left – and that is to ask for a judicial review of the decision. It is important to consider what a judicial review is, and the processes it involves. A body such as the FOS can have its decisions

reviewed by the courts, but the courts will only review final decisions, and will not accept a case for review where there is an alternative remedy available – such as returning to the FOS with an appeal. If a final decision has been reached and an insurer would like to take the matter further, it can then ask for a judicial review of the decision. The applicant (i.e. the insurer applying for the judicial review) will need to ask for permission to take the claim to the High Court. In that application, they will need to show, amongst other things, that they have sufficient interest in the matter – in the Europ Assistance case, there is little doubt that the insurer did have sufficient interest. They will also need to show the merits of the challenge, the importance of enforcing the law, the importance of the issue raised, the presence or absence of any other person with sufficient interest, the nature of the unlawful conduct alleged, and the role of the applicant in relation to the issues under consideration.To summarise, and to quote Halsbury’s Laws of England: “Judicial review is the process by which the High Court exercises its supervisory jurisdiction to review the lawfulness of an enactment or a decision, action or failure to act in relation to the exercise of a public function.” Insurers are not given long to apply for a judicial review – this must be done within three months of an FOS decision. The judge examines

the documentation provided with the application and if they consider the matter to be complex will arrange an oral hearing. A further three to four months down the line, the applicant will know whether they have been given permission for a judicial review. The application stage exists for a number of reasons, including to make sure applications are dealt with speedily and without unnecessary expense, and in particular to make sure that the application justifies a full investigation of the substantive merits of a case and that it is not frivolous or vexatious. When considering whether to refer an FOS decision for judicial review, notice should be paid to a number of statistics. In 2010, the Administrative Court received 10,600 applications for permission to apply for judicial review. Of these, only 460 made it through the first stage to be heard as substantive applications; of those cases that were heard, 260 were dismissed (55 per cent). These statistics include cases that are, of course, related to all manner of subject areas and are not exclusive to travel insurance or other insurance matters. However, it should provide an idea as to the difficulty placed on anyone

Up in a puff of smoke

Insurers are not given long to apply for a judicial review – this must be done within

three months of an FOS decision

www.itij.co.uk

NEWSANALYSIS 9

wishing to ask the Judiciary to review a decision of a body such as the FOS. To be successful, the applicant needs to show that the decision could not have been reached by a reasonable ombudsman. That can be difficult. The judge is also likely to refuse permission for a review where:•There has been unjustified delay in bringing the

claim;•There is an adequate alternative remedy available;•The claim is academic or purely hypothetical; or•The claimant has suffered no real injustice.The judicial review process itself is not particularly complex, although the arguments raised can be, and one needs to ensure that the paperwork submitted in an application is accurate, due to the probability of the application being resolved as a paper exercise.

McDonagh vs RyanairOf great interest at the moment is the European Court of Justices’ (ECJ) opinion in the Ryanair litigation on the meaning of ‘extraordinary circumstances’, and an airline’s responsibility to provide care and assistance to passengers. The ECJ has published an opinion stating that airlines are not exempt from the provisions of EC Regulation 261/2004 (the Denied Boarding Regulations) requiring them to pay for hotels, meals and drinks for stranded passengers even if the flight cancellation was beyond their control. The opinion follows a referral by the Irish Courts in the case of Denise McDonagh, whose flight from Faro to Dublin with Ryanair was cancelled during the Iceland volcanic ash cloud saga. During the ash cloud crisis, Ryanair alone cancelled 9,500 flights, despite protesting at the time that it was safe to fly and that the airline was ready and willing to service its passengers in the usual way. Ryanair sought to argue that the closure of airspace went beyond ‘extraordinary circumstances’ and therefore released the airline from its obligation to provide care and assistance in accordance with Articles 5 and 9 of the Regulations. The Advocate General has unequivocally rejected that argument and has drawn a clear distinction between the requirement to provide care and assistance and the requirement to pay compensation: care and assistance is aimed at meeting a passenger’s immediate needs on the spot; compensation is designed to redress the inconvenience caused by the last-minute cancellation of a flight. The tenor of the opinion is that excluding an airline’s liability due to the closure of airspace would defeat the very object of the Regulations, particularly in circumstances where passengers are stranded for several days with no other means of returning home. It will now be for national courts to determine what care and assistance is reasonable when deciding the claims of passengers on a case-by-case basis. Many airlines apply internal policies when determining claims, but are reluctant to reveal details of how they assess what is ‘reasonable’ and tend to settle cases where such policies are called into question, probably to avoid having to convince a court of its credibility. In his opinion, the Advocate General made specific reference to Ryanair’s EU 261 policy where a levy

per passenger is applied to cover the costs that it has incurred in meeting its obligations under the Denied Boarding Regulations. The Advocate General seems to approve of such an approach, commenting: “In so far as Ryanair passes on to passengers, as it is entitled to do, the costs incurred as a result of compensation, it is difficult to see how it can be suffering an inequitable imbalance.”

It is already accepted that an airline is not required to provide fixed compensation to passengers for cancellation where the airline can show this was caused by ‘extraordinary circumstances’ beyond the airline’s control. The ECJ is currently reviewing whether very long delays are effectively the same as a cancellation. This could give rise to additional liability

for airlines, which the wording of the Regulations never intended.The ECJ is currently flooded with referrals from domestic courts raising questions on the interpretation of the Denied Boarding Regulations. Many of these referrals have come about due to the exceptional pressures put on airlines, both logistically and financially, following the Icelandic volcano and heavy snow disruption in the winter of 2010-2011. In light of this, the EU has launched a review of passenger rights. Usually, consumer protection is put first in EU legislation, but it is anticipated measures will be introduced to reduce the responsibility of airlines for stranded passengers. In the meantime, this latest opinion represents another blow to airlines in a regulatory regime that favours the consumer. Travel insurers, however, may take some comfort from the decision, which squarely places liability for providing care and assistance to passengers with the airline. To become binding law, the opinion must be followed by the ECJ, but it is very unusual for the European Court’s judges to depart from the guidance set out in the Advocate General’s opinion. There has been a European public consultation, which closed on 11 March 2012, as to passenger rights and the revision of the Denied Boarding Regulation, with the aim of identifying the shortcomings of the Regulations – such as their not being enforced uniformly across the EU, and the consumer being unclear as to their redress following a delay or cancellation.

ConclusionIt is unfortunate that there was no judicial review of the FOS decision as applied for by Europ Assistance – not least as the consumer does have rights against other parties in the event of delay (such as the airline), and a court could have taken a more global view of the consumer’s situation. Hopefully, the European review will take a more holistic view and provide clarity as to who should foot the bill should this sort of event happen again. Both the airlines and insurers need clarity so as to price tickets and premiums correctly. No one needs to be reminded how expensive the volcano has been and insurers have rightly re-written a large number of policies to ensure that they are not caught out again by such

an explosion. Insurers should continue to consider judicial review of FOS decisions, as there is no real alternative; and despite the present case, there are success stories out there. There will be a public hearing in spring 2012, where a summary of the contributions to the public consultation will be presented to the EU Commission and where stakeholders will be given the opportunity to comment – and that should include travel insurers. n

The ECJ is currently reviewing whether very long delays are

effectively the same as a cancellation

Daniel Scognamiglio leads the Blake Lapthorn Travel team based in South-ampton, UK. He is a specialist in multi-jurisdictional disputes and travel insur-ance litigation holding dual qualification from England as a solicitor and the US as an Attorney at Law. He has worked on the leading cases involving the implication of the European motor directives on English law and recovered in-surers’ outlays worth over $2.5 million. Daniel’s expertise has seen him act for both claimants and insurers, mostly in contentious matters.

Chris Deacon joined the Travel team of Blake Lapthorn in January 2008 and qualified as a solicitor in 2011. Chris acts mostly for claimants in relation to acci-dents abroad and holiday disputes, as well as for travel and motor insurers on inter-national recoveries. He has a particular interest in consumer travel issues, claims under the Package Travel Regulations, international con-ventions and denied boarding cases.

International Travel Insurance JournalInternational Travel Insurance Journal

10 COMPANYBRIEF

NEWSWIRENorthern Irish firm B&W Software Enterprises Ltd has launched its latest app, Travel Angel, to travel insurers and ancillary companies. Available in Android, iPhone and Blackberry versions, the app allows automated transmission of details, including GPS co-ordinates, and secure storage of key data, for when emergency situations arise.

In line with its sales of car, motorbike and home insurance, Linea Directa in Spain has now started to offer travel assistance services, which covers road accidents occurring in Spain and the rest of Europe. The company’s travel insurance offering covers not only the vehicle, but the occupants inside it.

Medsave USA, a diversified healthcare services company, has announced that it has completed a consolidation of its former portfolio units, based in Florida and New York. MedSave Legal Services, MedSave Insurance Services and MedSave Healthcare are now consolidated, along with MedSave International and MedSave Administrative Services.

UK-based Neilson Holidays is joining the Use Your Head campaign that encourages winter sports enthusiasts to wear helmets. The campaign was first launched in 2010 by Essential Travel.

South African low-cost airline Kulula has introduced travel insurance to its offering, underwritten and powered by ACE Insurance. Adding the insurance policy to a flight ticket is a simple, one-click process.

US-based Spirit Airlines has teamed up with MyAssist to provide personal assistance and concierge services to Spirit Airlines customers. Services include trip planning logistics, securing reservations and event tickets, as well as providing emergency assistance in times of need.

UK-based online speciality insurer Protect Your Bubble is now available in the US, where it is offering insurance for gadgets, pets and travel, under the leadership of Stephen Ebbett, president of the company for Europe and North America.

Coalition America, a provider of healthcare cost containment services for medical, dental and workers’ compensation claims, has announced the company and its affiliate brands have been consolidated and rebranded as Stratose. The new brand, including name, logo and web presence, better reflects the company’s key market position.

Sallie Mae covers studentsUS-based Sallie Mae, a financial services company specialising in education, has introduced a travel protection offering aimed at students. Offered through the recently launched Sallie Mae Insurance Services programme, the company’s travel insurance includes benefits for trip interruption as well as other standard benefits, such as cash reimbursement that airlines and cruise companies may not provide in the event of trip cancellation. There is also protection for medical expenses incurred on holiday, as well as baggage protection and value-added travel assistance services.

Lloyds TSB enhances coverLloyds TSB in the UK has upgraded the travel insurance cover provided through its Silver, Gold, Platinum and Premier current accounts so that customers are automatically covered for any disruption to their travel as part of the policy. The new cover has been designed with independent travellers, who book their accommodation and transport separately, in mind. Such customers often don’t receive the protection afforded to those who book package holidays and could therefore find themselves without protection should a major event, such as a volcanic eruption, occur. The enhanced insurance offering provides cover for extra costs incurred for accommodation and transportation that they are unable to recover from another party; additional accommodation costs if accommodation is made unusable by fire, flood, earthquake or other natural disaster; and the cost of lost accommodation if a client is unable to travel to their chosen holiday destination.

CEGA launches new claims platformCEGA Group, the UK claims and emergency assistance provider, has invested in a bespoke IT solution that unites travel and private healthcare claims and emergency medical assistance in an effort to optimise customer satisfaction and resolution times.The system, which puts claims, assistance and sales data on a single platform and unifies case management, offers a single view of a claimant’s history, with built-in, tailored service level agreements and on-the-spot customer verification functions. The technology enables CEGA to offer a full service claims and assistance customer solution, with an online self-service portal for end client services, brokers, insurers and providers. Among its many other features are its capacity to extract and analyse claims and assistance data and management information, offering complete transparency to clients.“This investment enables CEGA to provide a seamless, efficient and integrated claims and assistance service, further reinforcing our clients’ brand values. It demonstrates CEGA’s commitment to be at the forefront of customer service technology,” said CEGA’s director of development Neil Heasman.

CSOS becomes compliantCSOSTM, which bills itself as China’s first emergency assistance specialist with a global servicing capability and hospital network, has announced that it is in full compliance with international emergency medical service (EMS) protocols as an initiative to promote best emergency care practices and medical excellence for government agencies, insurance companies, institutional clients and to the general public in China.“Patient care and safety are a top priority of an air or ground inter-facility medical transport service, and this compliance will ensure that our overseas and Chinese patients receive the best medical care in a medical emergency,” said Alina Zhuang, spokeswoman and chief operating officer of CSOS.Zhuang further explained that CSOS has now adopted the latest and most up-to-date medical resuscitation equipment available and the company is in compliance with the American Heart Association and American Emergency Physician guidelines on medical resuscitation, in addition to the advanced life support certificates held by CSOS’ medical staff. This has also made CSOS the first Chinese full-service medical assistance company to comply with international EMS protocols voluntarily, she said. “This compliance may not be achievable without the hard work of our diligent teammates, our international medical team in particular. This compliance will help further enhance CSOS’ presence in the Great China region, as a leader in the high-growing medical assistance industry,” added Zhuang.CSOS said it will be following CAMTS (Commission of Air Medical Transport Safety) and EURAMI (Europe Air Medical Institute) guidelines on safe medical evacuation of critically ill patients, and evaluating compliance with accreditation standards to demonstrate the ability to deliver high quality services.

Cover-More buys AOLAustralian travel insurance and assistance provider Cover-More has purchased Shanghai, China-based medical assistance company Assistance Online (AOL). Cover-More Group chief executive officer Peter Edwards said that the acquisition was part of the group’s strategic push into Asia, a region that is expected to show the world’s strongest growth in leisure and business travel in the coming years. Edwards went on to say that AOL currently provides medical and travel assistance and third-party

administration services from a 24-hour call centre in Shanghai, and has an established and extensive network of providers in China, Hong Kong, Singapore, Macau, Taiwan and Mongolia.Looking ahead, Edwards said: “Our immediate focus is to leverage the experience and expertise of AOL and enhance this with the systems and processes strength of our existing assistance business.

We will then use that combined capacity to extend the level of available assistance for both inbound and outbound leisure travellers and corporate travellers in China and throughout Asia and the Pacific.”

MAPFRE teams with CEA in FranceMAPFRE ASISTENCIA has signed a strategic agreement with France-based Compagnie Europeene d’Assurances (CEA) for joint operations in the travel insurance field in France. The agreement means that MAPFRE assumes the management and risk underwriting in this area. MAPFRE’s French subsidiary will provide all its worldwide experience in travel insurance, combined with the leading position enjoyed by CEA in the French market. CEA staff will join MAPFRE as part of the agreement.

One Source offers coverUS-based One Source Benefits, an established and licensed insurance broker, is offering an array of plans from several different travel insurance companies to students, individuals and families, as well as missionaries and business travellers. The company offers affordably priced student group plans for students going abroad, as well as student individual plans to travel across the US, travel home after a semester or travel abroad. As the firm pointed out: “Missionary work often takes people to distant and unfamiliar locations. The best way to safeguard such trips is with a Patriot Multi-Trip from One Source Benefits.”

Panama tempts touristsIn an effort to attract more tourists to the country, the government of Panama is now offering free travel medical insurance that covers them for the first 30 days they are on holiday. The insurance is organised through Assicurazioni Generali SpA, which won the $12-million, three-year contract with the Panamanian government.The Panama Tourist Authority has said that once visitors arrive in Panama City’s Tocumen International Airport, they can receive their health insurance brochure and medical expenses card from the tourism information centre. In an emergency, a tourist can simply present the card to the treating hospital or clinic and receive treatment for free, according to officials.Solomon Shamah, Panama’s director of tourism, said: “Health insurance is an incentive for tourists visiting Panama as well as other attractions of the country as a tourist destination.”The policy covers accidental death, hospitalisation and medical expenses up to $7,000, but excludes incidents caused by drugs, alcohol, negligence of the policyholder or extreme sports.

IAG reveals planFrance-based industry coalition the International Assistance Group has set its course for a fresh strategy that involves new partnerships being formed with providers. The organisation states: “Whatever the size, speciality or location, opportunities are now available for applicants to join this worldwide network. Major assistance companies as well as specialist providers will be able to reap the benefits of joining one of the three International Assistance Group partnerships.” To gain accreditation from the Group and access the operational and marketing benefits it holds, an application and assessment process must be completed.The primary objective of the network is to help its members grow organically, offering quality and health-focused outcomes. The International Assistance Group is a worldwide commercial alliance of independent companies spanning all the links in the assistance chain. Founded in 1992 by five European companies, the alliance enables all 42 partner organisations to reach more of the assistance market through close co-operation with other organisations in the network, thus increasing their competitiveness.

NEWSWIRENorthern Irish firm B&W Software Enterprises Ltd has launched its latest app, Travel Angel, to travel insurers and ancillary companies. Available in Android, iPhone and Blackberry versions, the app allows automated transmission of details, including GPS co-ordinates, and secure storage of key data, for when emergency situations arise.

In line with its sales of car, motorbike and home insurance, Linea Directa in Spain has now started to offer travel assistance services, which covers road accidents occurring in Spain and the rest of Europe. The company’s travel insurance offering covers not only the vehicle, but the occupants inside it.

Medsave USA, a diversified healthcare services company, has announced that it has completed a consolidation of its former portfolio units, based in Florida and New York. MedSave Legal Services, MedSave Insurance Services and MedSave Healthcare are now consolidated, along with MedSave International and MedSave Administrative Services.

UK-based Neilson Holidays is joining the Use Your Head campaign that encourages winter sports enthusiasts to wear helmets. The campaign was first launched in 2010 by Essential Travel.

South African low-cost airline Kulula has introduced travel insurance to its offering, underwritten and powered by ACE Insurance. Adding the insurance policy to a flight ticket is a simple, one-click process.

US-based Spirit Airlines has teamed up with MyAssist to provide personal assistance and concierge services to Spirit Airlines customers. Services include trip planning logistics, securing reservations and event tickets, as well as providing emergency assistance in times of need.

UK-based online speciality insurer Protect Your Bubble is now available in the US, where it is offering insurance for gadgets, pets and travel, under the leadership of Stephen Ebbett, president of the company for Europe and North America.

Coalition America, a provider of healthcare cost containment services for medical, dental and workers’ compensation claims, has announced the company and its affiliate brands have been consolidated and rebranded as Stratose. The new brand, including name, logo and web presence, better reflects the company’s key market position.


12 INSURANCEMATTERS

NEWSWIREIndiaforensic, which conducts security, risk management and forensic accounting research, has published research that it claims shows Indian insurance companies suffered a loss of over R300 billion (US$6.6 billion) in 2011. Fraudulent actions identified included collusion between insurance company employees and private individuals, document falsification and false reporting on the cause of death.

Ram Ratings (Lanka) has said that Sri Lanka’s insurance industry is likely to see consolidation in the long-term, particularly in the general insurance sector, as smaller insurance companies will feel pressurised by the government’s requirement that they separate their life and general insurance businesses into two new entities by 2015.

The Abu Dhabi National Insurance Company’s net profit grew over 11 per cent in 2011 to AED158 million (US$43 million), compared to 2010.

Allianz Global Corporate and Speciality has issued research that shows one year on from the catastrophic earthquake and tsunami in Japan, which saw record claims for businesses and supply chain interruptions, companies have moved to enhance their risk management of global supply chains.

An association of local councils in Queensland, Australia, have clubbed together to suggest that it could be more cost effective for big insurance companies to help ‘flood proof’ the state’s low-lying towns. However, the insurance industry has responded by saying it is not the industry’s responsibility.

Joe Plumeri, chairman and chief executive of Willis Group, said at a recent aviation insurance conference that air travel in Asia Pacific regions is set to surpass that in the US and Europe in the coming five years, thus increasing the exposure of airlines operating in the region to problems such as reputational risk.

Carlos Montalvo, executive director of the European Insurance and Occupational Pensions Authority, has said that policymakers should not let politics impede the implementation of Solvency II regulations.

The World Bank has urged officials in China to unify its financial regulators and functional supervision in an effort to improve the ability of such regulators to deal properly with cross-industry financial risks. The Bank believes that the concept of developing a strong macro-prudential framework is not yet fully rooted in the Chinese financial regulation system.

Business Today in India has reported that insurance companies in the country are starting to underwrite new types of insurance policy, which include e-medical consultation services, cover for amateur sports, bail bond cover and insurance against lost keys.

Chairman of the Indian Insurance Regulatory and Development Authority J. Hari Narayan has sent a letter to all life insurance company chief executives, warning them that some of the products that are being proposed to it ‘are not in alignment with best practices and frequently lack clarity’.

Ernst & Young’s latest Global Insurance Customer Survey has found that Asian customers are demanding simpler products that are easier to understand.

QBE unifies under one brandQBE Insurance Group, one of Australia’s largest insurance groups, has announced its intention to combine its global insurance operations under one single management team and a unified brand, QBE Re. The newly re-organised business will be led by Jonathan Parry, formerly European chief underwriting officer for reinsurance, and will have a gross written premium of over US$1.5 billion across a portfolio that includes property and casualty as well as speciality lines. A statement from QBE said the model ‘will allow QBE Re to offer its clients a consistent underwriting philosophy’.Parry further explained: “This global approach allows us to create a platform where we can provide the best possible service to our clients worldwide. Our business philosophies, market approach and appetite will be co-ordinated, which in turn will help ensure greater consistency across underwriting, pricing, risk management and reserving.”John Neal, chief executive officer of global underwriting operations, added: “The establishment of QBE Re strongly underlines QBE’s commitment to the reinsurance market. We believe our clients will welcome the move to unify our reinsurance businesses. By retaining our deep local underwriting expertise, and supplementing it with benefits provided by a global organisation – scale, consistency, flexibility, capacity and improved service.”

Reinsurance agreements delayedThe losses seen from catastrophes in 2011 have driven up insurance premiums in India so significantly that general insurers are said to be delaying finalising their reinsurance agreements in order to align premium growth with reinsurance cover.The Indian Financial Chronicle newspaper cited Swiss Re’s managing director for Indian operations Dhananjay Date as saying: “Treaties are delayed in view of the catastrophe losses of last year.” He went on to add that it is a global trend that is being seen in other parts of the world as well.Ritesh Kumar, managing director and chief executive of HDFC ERGO, confirmed: “This year, there has been some delay in negotiations because of the uncertainty on how rates will shape up. We are still negotiating the contracts with reinsurers.”The newspaper also pointed out that the delays are due, in part, because domestic insurance companies still need to finalise their retentions, which itself comes as a result of exposure to losses in Japan, New Zealand, Australia and Thailand.

The devastating floods in Thailand late last year could mean much larger losses for Asian insurers than early indicators suggested, according to Standard & Poor’s Ratings Services. The rating agency estimates the current gross losses for insurers at about US$16

to $18 billion. In a report titled Thai Floods Dampen Asian Insurers’ Earnings And Capitalization, Standard & Poor’s (S&P) also suggests that the higher-than-estimated losses could lead to negative rating actions on insurers in the region.Insurers and reinsurers’ earnings announcements over the past few months have given a better picture of the possible extent of the losses, while on-the-ground assessments by loss adjustment teams have led some insurers to raise their net loss estimates, in some cases by up to three times the initial estimate. “Our outlook for the insurance industry in Thailand remains negative, reflecting our expectation of significantly lower earnings and possibly weaker capitalisation among affected insurers,” said S&P credit analyst Connie Wong. “Some companies may have sufficient reinsurance protection for ultimate losses or external sources for capital. However, overall we expect the Thai insurance sector to report bottom-line losses.”

The report says that insurance losses have been so high in the Thai insurance industry that it has changed S&P’s opinion on those markets being catastrophe-remote. “We expect the terms and conditions on catastrophe

reinsurance to continue to tighten and catastrophe reinsurance capacity to remain tight, with reinsurance pricing on catastrophe perils increasing significantly. However, we expect the underlying pricing for the non-catastrophe business to remain competitive and offset the overall upward pricing trend, especially in the Thai market,” said Ms Wong. S&P estimates accumulated gross losses for the big three Japanese insurance groups at JP¥920 billion (US$11.9

billion) with net losses of ¥447 billion ($5.8 billion). The big three are: Tokio Marine Group; MS&AD Insurance Group; and NKSJ Group. S&P believes that flood losses constitute more than two-thirds of the absolute loss because key losses have been from industrial parks, which have significant Japanese investment. Consequently, Japanese insurers have been hard hit despite their strong financial profiles. The report notes that small regional reinsurers and local insurers would suffer the most if ultimate net losses are larger relative to capitalisation. Losses of both local insurers and regional reinsurers could escalate sharply once their reinsurance protection is exhausted. While regional insurers and reinsurers will bear most of the Thai flood-related losses, global reinsurers will inevitably pick up some of these losses through their exposure to regional players. Nevertheless, global reinsurers’ strong capitalisation and reinsurance or retrocessional cover should enable them to absorb these losses.

Thai flood warning from S&P

www.itij.co.uk

INSURANCEMATTERS 13

NEWSWIREIndiaforensic, which conducts security, risk management and forensic accounting research, has published research that it claims shows Indian insurance companies suffered a loss of over R300 billion (US$6.6 billion) in 2011. Fraudulent actions identified included collusion between insurance company employees and private individuals, document falsification and false reporting on the cause of death.

Ram Ratings (Lanka) has said that Sri Lanka’s insurance industry is likely to see consolidation in the long-term, particularly in the general insurance sector, as smaller insurance companies will feel pressurised by the government’s requirement that they separate their life and general insurance businesses into two new entities by 2015.

The Abu Dhabi National Insurance Company’s net profit grew over 11 per cent in 2011 to AED158 million (US$43 million), compared to 2010.

Allianz Global Corporate and Speciality has issued research that shows one year on from the catastrophic earthquake and tsunami in Japan, which saw record claims for businesses and supply chain interruptions, companies have moved to enhance their risk management of global supply chains.

An association of local councils in Queensland, Australia, have clubbed together to suggest that it could be more cost effective for big insurance companies to help ‘flood proof’ the state’s low-lying towns. However, the insurance industry has responded by saying it is not the industry’s responsibility.

Joe Plumeri, chairman and chief executive of Willis Group, said at a recent aviation insurance conference that air travel in Asia Pacific regions is set to surpass that in the US and Europe in the coming five years, thus increasing the exposure of airlines operating in the region to problems such as reputational risk.

Carlos Montalvo, executive director of the European Insurance and Occupational Pensions Authority, has said that policymakers should not let politics impede the implementation of Solvency II regulations.

The World Bank has urged officials in China to unify its financial regulators and functional supervision in an effort to improve the ability of such regulators to deal properly with cross-industry financial risks. The Bank believes that the concept of developing a strong macro-prudential framework is not yet fully rooted in the Chinese financial regulation system.

Business Today in India has reported that insurance companies in the country are starting to underwrite new types of insurance policy, which include e-medical consultation services, cover for amateur sports, bail bond cover and insurance against lost keys.

Chairman of the Indian Insurance Regulatory and Development Authority J. Hari Narayan has sent a letter to all life insurance company chief executives, warning them that some of the products that are being proposed to it ‘are not in alignment with best practices and frequently lack clarity’.

Ernst & Young’s latest Global Insurance Customer Survey has found that Asian customers are demanding simpler products that are easier to understand.

Having experienced a decline in profitability as a result of the global financial crisis, insurance companies worldwide are refocusing their internal operations, with attention on reducing costs and improving the efficiency of their business processes through transforming policy administration, according to the recently released Capgemini and Efma 2012 World Insurance Report.The 2012 World Insurance Report explores ways insurers can dissect their business to identify opportunities that will make fundamental and lasting improvements to their core operations. It draws on research insights from 19 markets including: Australia, Austria, Belgium, Brazil, Canada, Denmark, France, Germany, Hong Kong, India, the UK, the US and Vietnam. The report draws three clear conclusions, according to the authors: managing costs and efficiencies are critical levers of insurers’ performance; insurers indicate policy administration as their next priority; and making investments in several policy administration sub-functions is important for insurers to achieve business agility in the years to come.Regarding costs and efficiencies being the critical levers of performance today, the report states that although premium volumes are rising in some markets, few insurers are in a competitive position to raise rates. Additionally, many insurers face the difficult task of growing their top line as customers increasingly focus on price and the industry’s commoditisation. Insurers, especially in non-life (i.e. property and casualty), need to achieve sustained performance in the coming years and emphasise key components of underwriting performance. They also need to consider ways to minimise claims, acquisition and other operational costs while growing their

business. Core operational functions, such as policy administration, offer one of the few remaining areas in which transformation can deliver both cost savings and customer benefits.The report moves on to address the realisation that policy administration is the next priority to achieve cost and operational efficiency: “Globally, many leading insurers acknowledge they cannot continue to rely on ageing and inflexible policy administration systems, which lock them into legacy business practices and inhibit their ability to compete in a customer-centric market. Policy administration transformation was identified as a priority in the next two years by a vast majority of European (93 per cent) and North American insurers (67 per cent).” However, in the Asia-Pacific region, only 36 per cent of respondents indicated it was a key priority, as insurance markets recently opened to private players only in the last decade, allowing many entrants to immediately deploy modern policy administration systems.“Policy administration transformation is fundamentally critical for insurers who are up against today’s challenging economic backdrop and new competitive environment where the right opportunities for improving margin and top-line growth are hard to find,” said Jean Lassignardie, vice-president, sales and marketing for Capgemini’s financial services global business unit. “In such conditions, we see insurers modernising legacy policy systems to achieve streamlined operations with much needed reductions in operational costs. This same path is serving to capture efficiencies that ultimately lead to improved time-to-market, increased customer satisfaction and better servicing of policies.”

Risk technology survey offers insightsAon eSolutions, the technology solutions business of Aon Corporation, has released the results of its 2012 Global Risk Technology Survey, which gathered information from more than 400 risk professionals

from 57 countries on how leading organisations view and use risk technology. The report offers a deeper understanding of how the use of risk technology has an impact on an organisation’s risk and data management and total cost of risk.According to the survey, the number one benefit and driving force behind the use of risk technology is accurate and reliable data. The result, which was similar to the last survey in 2009, indicates that organisations use risk management information systems, commonly known as RMIS, to manage

business operations and generate accurate financial information. The top 10 benefits of technology, according to the results of the survey, are: accuracy and reliability of data; automation of processes; data consolidation and management; management reporting improvements; risk management process improvement; ease of access to data from one location; communications improvement; increased awareness; total cost of risk reduction/management (TCOR); and auditability. The survey also showed that compliance was one of the newer benefits of using RMIS.“Compliance is a relatively new topic in the risk management industry, and as more companies explore cloud offerings to store and report on their organisational data, compliance may well make an appearance in the top 10 in our next survey,” said Kathy Burns, chief executive officer of Aon eSolutions.The report also reveals a key trend that demonstrated how more organisations are now closely tracking return on investment (ROI) for risk technology tools. For example, more than 25 per cent of respondents said they expect to save up to $50,000 per year from using risk/insurance and claims technology. “Companies are actively tracking the ROI for risk technology investments. This indicates the technology is becoming critical in the way organisations do business and is seen as an added value in reducing TCOR,” added Burns.Absent from the top 10 this year were claims management and control and transparency, which is surprising given that historically, claims management has been the primary rationale for implementing risk technology. However, today RMIS are used to manage much more than workers’ compensation claims reporting. Meanwhile, control and transparency may have dropped off the 2012 survey as risk management departments have become more visible to boards of directors and CFOs, who look to these departments to inform and guide their organisations in all aspects of risk.

Profit decline moves focus Fitch publishes special reportFitch Ratings has recently published a special report titled Insurer Ratings Drop Modestly over 2007-2010, Now Stable, which discusses the ratings performance of Fitch-rated insurance companies through the recent three-year period. Over this period, North American and European insurers experienced widespread rating downgrades, as 50 per cent of the insurers reviewed in the study had their ratings downgraded by at least one notch. Of the insurers downgraded, nearly three-quarters of those downgrades were limited to one or two notches.Most of the downgrades were a direct result of a drop in invested asset values, primarily related to mortgage-backed and corporate bond securities, while investment losses resulted in declines in capital to levels inconsistent with prior ratings. Some insurers’ capital balances, though, were also affected by the large stock market drop, which weakened asset values and increased variable annuity liabilities on product guarantees. Ratings have not returned to the higher 2007 level despite improvements in capital, as they remain weighed down primarily by global economic weakness and sovereign challenges. These features have dampened earnings and have generally increased uncertainties. In the report, Fitch Ratings stated: “When global macro issues subside, assuming capital quality and other rating factors remain where they are today or improve, Fitch believes some rating upgrades may be possible on a case-by-case basis. However, it is unlikely that ratings will fully return to 2007 levels as the volatility experienced in the period exceeded Fitch’s prior expectations. This has caused [our] perception of investment risk to increase, with ‘tail events’ and stress scenarios now more heavily considered.”

Health update from IndiaFigures from Towers Watson India have shown that the health insurance sector in the country continues to grow at a healthy pace. As per statistics released by the Insurance Regulatory and Development Authority (IRDA), the industry recorded 21.3-per-cent growth in gross premium written in the first half of the 2011-12 financial year, as compared to the same period in the previous financial year.The health insurance portability facility, which was earlier scheduled to become operational from July 2011, was finally implemented in October last year. Towers Watson commented: “Portability will allow health insurance policyholders to switch companies while retaining their no-claims benefit. It is likely that consumers can now expect a slew of innovative health insurance plans as insurers compete to attract and retain customers. Insurers, however, say that the cost of health insurance is unlikely to come down.”The central and the state governments are taking a number of initiatives to revamp and expand the network of existing government health schemes. The central government plans to introduce a universal health insurance scheme with premiums linked to income levels. The Planning Commission has suggested implementing a government-funded health insurance plan, covering all the citizens of India, by 2017.Meanwhile, an analysis of medical benefits by Towers Watson has shown that 66 per cent of Indian companies made changes to the terms and conditions within their medical insurance policies in the past two years. The reason behind this trend, said Anuradha, benefits director at the company, is: “The growing cost of managing healthcare costs such as rising insurance premiums and medical costs are increasingly worrying chief executive officers and chief financial officers, and not just the HR teams.” Changes to policies noted by Towers Watson include adding co-payment clauses, setting cost limits and placing restrictions on certain chronic diseases.

The Singapore domestic general insurance industry registered strong growth amidst global economic uncertainty and huge catastrophic losses experienced in other markets, according to the latest report issued by the General Insurance Association of Singapore. Total gross premiums went up by 4.5 per cent to $3.17 billion last year, an increase from $3.03 billion in 2010. The industry’s total underwriting profit shot up 25 per cent to reach $248.3 million in 2011, up from $198.1 million in 2010. Leading this upsurge in profit was motor insurance, with an increase of 143 per cent after four years of losses.All major classes of business posted growth, with the health insurance sector recording the highest climb in earned premiums at 14 per cent after seeing no growth in 2010. Personal accident came in second with eight per cent growth, followed by motor at 4.5 per cent. After recording a 14-per-cent decline in earned premiums, marine cargo posted a healthy gain of four per cent, followed by work injury compensation at 3.7 per cent and fire at 2.3 per cent. Marine hull made the least growth of all major segments with only 0.3 per cent, down from four per cent in 2010.Motor sprang back to a state of health with an underwriting profit of $21.2 million – a robust rebound from a loss of $48.9 million in 2010. The last time it saw an underwriting profit was in 2005 ($46.4 million), one of the only three years in which motor made a profit in the past 11 years. These profits, though, paled in comparison with the

underwriting losses motor incurred in the past 11 years, with 2008 recording the biggest loss in that period at $214.1 million, followed by 2002 with $124 million. In all, motor registered an aggregate underwriting loss of $588 million in the last 11 years. Motor’s premium growth, on the other hand, had been on a stable track since 2007 from a declining course from 2004 to 2006. Last year’s earned premium stood at $1,087 billion, up 4.5 per cent from $1,041 billion in 2010.From being 2010’s brightest performer with an underwriting profit soaring 141 per cent to $5 million, work injury compensation posted the biggest profit decline last year among all the major classes, with an underwriting profit of $3.6 million, a dip of 28 per cent. Nonetheless, this was still a better performance compared to its underwriting loss of $12 million in 2009. Earned premiums grew slightly to $242.1 million, up 3.7 per cent from $233.4 million in 2010.Personal accident delivered another healthy growth of eight per cent in earned premiums with $202.5 million, up from $187.6 million in 2010. However, it suffered a decline in underwriting profit from $49.6 million in 2010 to $44.9 million last year, down by 9.5 per cent.Health made the biggest gain in earned premiums last year with $142 million, up 14 per cent from $124.7 million in 2010. It also made a robust recovery in underwriting profit. From a decline in 2010, underwriting profit surged by 91 per cent to $8.8 million in 2011.

Singapore enjoys surging profits


14 INSURANCEMATTERS

Global bank HSBC has agreed to sell its general insurance businesses in Hong Kong, Singapore, Argentina and Mexico to AXA and QBE, as well as signing a 10-year exclusive bancassurance partnership with the companies to allow them to sell insurance products to consumers in Hong Kong, mainland China, Singapore, India, Indonesia, Mexico and Argentina. AXA is to pay US$494 million in cash for the business, with QBE paying a further $420 million. In total, the gross value of the assets being purchased is $1.23 billion, approximately $444 million of which is being bought by AXA and $748 by QBE. Australian-based QBE is buying the businesses HSBC Argentina Holdings SA and Hang Seng Bank Ltd, both indirectly owned subsidiaries of HSBC Holdings plc.Commenting on the acquisition, John Neal, QBE’s chief executive of global underwriting operations, said: “The acquisition of the HSBC business in Argentina opens up an alternative distribution channel, complementary to our existing focus on workers’ compensation business. The acquisition of the Hang Seng

general insurance business in Hong Kong will provide increased penetration into the local market as well as opportunities for further growth through the long-term bancassurance distribution arrangement.”

Stuart Gulliver, chief executive of HSBC, said the assets are not viewed as being core to the company’s future, adding: “It [the sale] will enable us to focus our capital and resources on the growth of our core businesses, including the building of our broader wealth management capabilities.”

NEWSWIREThe Vietnamese life insurance sector has reported that the industry saw premium value reach VND16 trillion (US$768 million) in 2011, a year-on-year increase of 17 per cent. There are currently 14 life insurance firms in operation in Vietnam, only one of which is based in the country.

Dr Richard Ward, chief executive of Lloyd’s of London noted at the recent 12th Asia CEO Summit in Singapore that like 2011, 2012 is a challenging year for the industry as it faces pressure in premiums and investment income amidst the threat of another global economic slump.

Dow Jones has reported that the top three non-life insurers in Japan – Tokio Marine Holdings, MS&D Insurance Group Holding and NKSJ Holdings – have all seen their balances severely affected by the US$5.3-billion payment made to Japanese manufacturers as a result of the flooding in Thailand last year.

Moody’s Investors Service has downgraded the financial strength rating of Generali and Allianz because of their exposures to the economic strife seen in Italy and Spain. The agency also cut the outlook of AXA and Aviva to negative from stable.

The Vietnamese government has introduced an insurance market development plan for the 2011-2020 period, hoping that by stimulating the market, it can reach its goals. It is hoped that by 2015, insurance premiums will account for around three per cent of GDP, climbing to four per cent of GDP by 2020.

PricewaterhouseCoopers executive director in Malaysia Angie Wong has said that despite measures and policies to combat motor insurance fraud, further collaboration between insurance practitioners, adjusters and garages is needed to strengthen and improve fraud detection rates.

Insurers with the Insurance Council of Australia have started to send their policyholders warning text messages when severe weather is going to strike in an effort to avoid huge claims. The annual bill for insurance payments for cars affected by hail storms is estimated to be millions of dollars.

A KPMG survey of Chinese consumers found that insurers in the country can expect to benefit from rising demand for healthcare and long-term savings products. The most popular products identified by the survey were accident insurance and critical illness cover.

Global lessons can be learntLeading international insurance economics think tank The Geneva Association has published Geneva Report No 5 Extreme events and insurance: 2011 annus horribilis, a global and detailed picture of the major 2011 natural catastrophes and an analysis of the role and mechanisms of insurance in managing climate risk and other extreme events.The report comprises nine essays by leading insurance academics, economists and insurers that underline the significant importance of risk adaptation and management measures in developing physical and economic resilience to natural catastrophes, including the important role of insurance in such mechanisms. It also provides the implicit ‘lessons learned’ from the catastrophes that will enable better risk assessment and adaptation to similar risks in future. “Predictions suggest that by 2025, more than 5.5 billion people worldwide will live in cities and a large proportion of them close to regions prone to extreme events,” said Walter R. Stahel, vice-secretary general and head of the risk management programme of The Geneva Association. “It is also likely that powerful extreme events will affect several of these large urban areas in the coming decades. Governments and decision-makers should keep the dramatic events of 2011 in mind and recognise the potential seriousness of this situation. The insurance industry is one part of any solution for efficient catastrophe risk management. Without a real effort from all stakeholders, including governments, to develop and implement such programmes, it seems inevitable that the worst is yet to come.”Michael Butt, chairman of AXIS Capital Holdings and co-chair of The Geneva Association’s Climate Risk and Insurance Project said: “The nature and scale of the challenge of natural catastrophes is greater than can be covered by insurance alone. The principle reason for increasing damage and loss figures are more socio-economic changes rather than changes of natural variability. A closer co-operation and collaboration between governments, industry and insurers is needed to manage disaster risks and to reduce the financial impact of extreme events.”

HSBC sells insurance assets

HSBC’s Shanghai office

www.itij.co.uk

INSURANCEMATTERS 15

NEWSWIREThe Vietnamese life insurance sector has reported that the industry saw premium value reach VND16 trillion (US$768 million) in 2011, a year-on-year increase of 17 per cent. There are currently 14 life insurance firms in operation in Vietnam, only one of which is based in the country.

Dr Richard Ward, chief executive of Lloyd’s of London noted at the recent 12th Asia CEO Summit in Singapore that like 2011, 2012 is a challenging year for the industry as it faces pressure in premiums and investment income amidst the threat of another global economic slump.

Dow Jones has reported that the top three non-life insurers in Japan – Tokio Marine Holdings, MS&D Insurance Group Holding and NKSJ Holdings – have all seen their balances severely affected by the US$5.3-billion payment made to Japanese manufacturers as a result of the flooding in Thailand last year.

Moody’s Investors Service has downgraded the financial strength rating of Generali and Allianz because of their exposures to the economic strife seen in Italy and Spain. The agency also cut the outlook of AXA and Aviva to negative from stable.

The Vietnamese government has introduced an insurance market development plan for the 2011-2020 period, hoping that by stimulating the market, it can reach its goals. It is hoped that by 2015, insurance premiums will account for around three per cent of GDP, climbing to four per cent of GDP by 2020.

PricewaterhouseCoopers executive director in Malaysia Angie Wong has said that despite measures and policies to combat motor insurance fraud, further collaboration between insurance practitioners, adjusters and garages is needed to strengthen and improve fraud detection rates.

Insurers with the Insurance Council of Australia have started to send their policyholders warning text messages when severe weather is going to strike in an effort to avoid huge claims. The annual bill for insurance payments for cars affected by hail storms is estimated to be millions of dollars.

A KPMG survey of Chinese consumers found that insurers in the country can expect to benefit from rising demand for healthcare and long-term savings products. The most popular products identified by the survey were accident insurance and critical illness cover.

The US Treasury has announced its plans to sell shares in AIG in the latest stage of the gradual sale of the 77-per-cent stake it still holds in the insurer. When it bailed out AIG in September 2008, it did so with $180 billion; the latest share sale would see around $6.9 billion of that holding sold. 2012 has so far been kind to AIG, which has witnessed a 27-per-cent rise in value since the beginning of the year. Robert Benmosche, chief executive of AIG, said of the share sale: “The people of AIG have achieved another significant milestone in our progress towards our goal that American taxpayers recoup their entire investment in AIG at a profit.”Just before the announcement came from the

Treasury, AIG announced its fourth-quarter 2011 results, which showed an after-tax operating income of $1.6 billion, which is a significant improvement on the third quarter of the year. For the full year 2011, net income attributable to AIG was $17.8 billion, compared to $7.8 billion in 2010.Benmosche said of the results: “Fourth-quarter and full-year profitability reflects the tremendous commitment and focus on business fundamentals by everyone at AIG. The quality of our earnings, against the backdrop of record catastrophes, enables this great company to again stand proud as a market leader.” He added: “Two years ago, sceptics – and even some supporters – thought it inconceivable that we would be in a position

to post our second consecutive annual profit. During 2011, we completely repaid the Federal Reserve Bank of New York Credit Facility and restructured the US government ownership to provide the US Department of the Treasury a clear exit path, while maintaining our investment grade ratings.”In related news, AIG has sold more than a third of its outstanding stake in Asia-based AIA, raising around $6 billion, which it plans to use to pay down even more of the debt the company owes the Treasury. AIA said: “This placing of AIA shares is one of the largest ever undertaken in Asia and its successful completion in such a short timescale demonstrates the market’s demand for AIA.”

European insurers look EastMoody’s Investors Service urged European insurance companies to increase their presence in Asian markets, apart from in Japan, as currently their presence in the marketplace is still too small to significantly affect their overall financial gain. Antonello Aquino, senior vice-president at Moody’s Investors Service, further explained: “We believe that over the longer term, European insurers’ credit profiles might benefit from a profitable expansion in Asia, due to the added geographical diversification and profitability benefits that this would bring to their portfolios.”He recognised the challenges and obstacles in the Asian market that could deter some European insurers, citing abrupt regulatory changes and embedded product guarantees, but added: “As a consequence, and perhaps more than in other regions of the world, the ability to manage regulatory environments, maintain product innovation and control distribution are the hallmarks of successful insurers in Asia ex-Japan.”The Moody’s report states that European insurers’ overall market share in Asia’s life insurance market stands at just below 10 per cent of the total regional annual premium income. The insurer with the most significant share of the market, Aquino noted, is British insurer Prudential plc, which has a substantial presence in most of the major Asian insurance markets.In March, Prudential announced that it might move its headquarters away from London, UK, as a means of avoiding the Solvency II capital requirement legislation. Although the company declined to specify where it would move to, industry speculation has centred on Asia, where around 45 per cent of the company’s sales are generated. “Prudential regularly reviews its range of options to maximise the strategic flexibility of the group. This includes consideration of optimising the group’s domicile, including as a possible response to an adverse outcome on Solvency II,” the company’s statement said. “There continues to be uncertainty in relation to the implementation of Solvency II and implications for the group’s businesses. Clarity on this issue is not expected in the near term.”ITIJ heard from Rab Stavrou, director of consultancy at Northdoor, an IT consultancy specialising in the insurance sector, who said: “It is indeed cause for concern that Prudential, one of the UK’s largest insurers, is considering to relocate its headquarters out of London. However, this cannot be viewed purely as a direct impact of Solvency II. This trend is not unique to the insurance sector and can be seen in banking and other industries. Companies relocating is a wider business ecosystem issue that the Government and regulators have been trying to address.”

AIG’s Treasury-owned shares up for sale


16 HEALTHMATTERS

Bird flu emerges againA report from the International Society for Infectious Diseases detailed the case of a man suffering from bird flu in a critical condition in southern Vietnam – the 22-year-old was the fourth person to contract the virus in 2012, sparking fears among health officials that the disease could be making a comeback. There have been two deaths in the same region – Binh Duong province – the most recent victim was taken to hospital on 17 February with a high fever and respiratory failure. It is thought he caught the virus as a result of eating duck blood pudding – a kind of noodle soup that is served with pieces of congealed blood. The area around the victim’s home has been disinfected and in an effort to ensure the virus spreads no further, the Animal Health Department has prepared 1.2 million doses of the bird flu vaccine, which it started administering in March. In Indonesia, four deaths from bird flu have also been confirmed in 2012, despite claims from the government that the disease is under control.There have been two studies undertaken recently to investigate the ability of the bird flu virus to mutate and spread more easily between humans – one in the Netherlands, and the other in the US. The results of these studies, though, have so far been suppressed due to concerns about terrorists using the information contained in the studies to create bioweaponry.

Dengue tips offeredDr Robert Wheeler, in-house medical director at US-based On Call International, has offered travellers his top five tips for avoiding being struck down by dengue fever while they are abroad. Transmitted by the aedes mosquito, dengue fever typically occurs in tropical and sub-tropical areas of the world, specifically South America, Central America, the Caribbean and Southeast Asia.Dr Wheeler’s first tip to travellers is stay protected, and he recommends that tourists visiting such areas wear loose, long-sleeved shirts and long trousers when they are outdoors. The second recommendation is to repel the mosquitoes, he said: “Look for a repellent that contains one of the following ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.” He did warn, though, that while repellents with a high concentration of such ingredients will protect for a longer period of time, concentrations over 50 per cent do not offer a marked increase in protection time. The third protection measure Wheeler recommends is to stay in hotels or resorts that are well screened or air conditioned, and that take measures such as spraying with insecticide to reduce the mosquito population nearby. He also noted that early clinical diagnosis and careful clinical management by experienced physicians increases the survival of patients, so it is important to get a bite checked out. Finally, he added: “If you get sick with a fever during or after a trip abroad, you should seek medical care right away. Be sure to tell the doctor or other healthcare provider about your recent travel [as] if you have become infected, early recognition and prompt supportive treatment can substantially lower the risk of developing severe disease.”The risk of dengue to travellers continues, with various reports from around the world confirming the presence of the malaria-carrying aedes mosquito. Officials in Cairns in northern Australia have begun a spraying regime in the town after a woman was confirmed to have contracted the virus, and a spokesman for Queensland Health said authorities were concerned about more cases emerging. Dr Steven Donahue said: “This is a very serious situation that could be the start of quite a big outbreak.”There have also been confirmed outbreaks of the virus in Lahore in Pakistan, the State of Punjab in India and in New Zealand.In related news, health authorities in Cuba have announced plans to launch clinical trials of an anti-dengue fever vaccine later this year. Dr Gerado Guillen, research director of the United Nations-backed International Centre for Genetic Engineering and Biotechnology, said that results from trials with monkeys had produced ‘satisfactory’ results, adding that the results pointed to ‘the possibility of protecting against the disease’.

ECDC issues threats reportThe European Centre for Disease Control and Prevention (ECDC) has issued its latest Communicable Disease Threats report, which contains up-to-date information on outbreaks of disease and infection around the world. The report includes an epidemiological summary of the measles outbreak that is continuing in different countries.In the UK, there have been 13 confirmed cases of measles in England, and 16 suspected cases so far this year – six of the cases were hospitalised. Elsewhere in Europe, Romania has reported an ongoing outbreak of the disease, while in Spain media reports have shown that an outbreak in the Alicante area is growing, with more than 175 cases reported there since the beginning of the year. In Sweden, a cluster of cases has been reported in Jarna – the first case was an adult who caught measles while travelling and gave it to his children, who then subsequently passed the disease on to a friend. In Ukraine, the number of measles cases is significantly higher at 3,162, according to figures from the country’s Ministry of Health. In the neighbouring Russian Federation, an outbreak of 130 cases has been reported in St Petersburg. The outbreak started as a nosocomial outbreak in a children’s hospital and has since spread to several districts within the city.The ECDC said: “The number of measles cases reported in 2011 is comparable to the number in 2010 but three to five times higher than the number of cases in the 2006 to 2009 period. Transmission follows the traditional seasonal pattern of measles in Europe. The number of new cases is expected to increase in the coming months.”

Kenyan travellers infectedThe UK’s National Travel Health Network and Centre (NaTHNaC) has announced that trypanosomiasis has been reported in two European tourists who visited Kenya this year. The tourists, one Belgian and one German, have both been diagnosed and treated for the disease following a holiday in Kenya that included a two-day excursion to the Masai Mara National Game Reserve. Trypanosomiasis is also known as sleeping sickness, and is transmitted by the bite of the tsetse fly. There are two different variants of the disease – Eastern and Western African – and the variant from East Africa tends to be a rapidly progressive disease, characterised by a chancre at the site of the fly bite, with fever, headache, fatigue, muscle ache and swollen lymph nodes being other symptoms.The NaTHNaC website stated: “In 2000 to 2010, a total of 94 cases of trypanosomiasis were reported from non-endemic countries. The majority were brucei rhodesiense infections reported in tourists returning from Tanzania. Other countries of acquisition reported were Malawi, Zambia, Zimbabwe and Uganda.” It adds that cases that have been imported to the UK and Europe in the last few years have for the most part been acquired in Tanzania, Malawi and Uganda. Travellers are advised to take anti-bite measures, including wearing long clothing and using an insect repellent that contains at least 30 per cent DEET.

Lassa outbreak continuesThe Nigerian Federal Ministry of Health has confirmed that the outbreak of Lassa fever it first recognised in January is continuing, with a reported 397 cases so far, 87 of which have been confirmed. A total of 40 deaths have been recorded, including six among health workers treating the victims. The Ministry sent a rapid response team to the 12 affected states to increase the level of surveillance, verify cases, support treatment initiatives and trace contacts of those thought to be suffering from the disease. Volunteers from the International Federation of Red Cross and Red Crescent Societies are supporting the effort as well as carrying out community activities to highlight good hygiene and sanitation practices.The UK’s National Travel Health Network and Centre has said that Lassa fever is a rare risk for travellers, although those at a greater risk of contracting the disease include people living or working in areas where it is endemic, such as healthcare or humanitarian workers or those undertaking rural pursuits such as camping.

Monkey troubleTravelvax Australia, which offers travel health services, has urged travellers to give monkeys a wide berth at temples in Southeast Asia, or in animal shelters or game reserves in Africa. The company said that according to a report from GeoSentinel, a global network of travel medicine clinics that are part of the International Society of Travel Medicine, there has been a sharp rise in the number of travellers being bitten by monkeys in Bali in particular over the last few years. It notes that while reports of monkey bites in Bali are not uncommon, since the rabies outbreak the island witnessed in 2008, the number of monkey bites being reported outweigh the number of dog bites as the main reason for international travellers returning home and having to seek post-exposure rabies treatment.Travelvax warned tourists about certain actions they should not try when faced with a monkey: don’t smile, don’t play tug of war, don’t share food, don’t

grab them, and don’t panic. The company added: “It is worth noting that while monkeys can transmit rabies, Asian primates rarely transmit the disease. Almost all of the average 55,000 rabies deaths worldwide each year are the result of dog bites.” It went on to ‘strongly advise’ travellers who are bitten to have rabies immunoglobin administered as soon as possible, even if it means abandoning the holiday.


18 TRAVELMATTERS

Travel truths unravelledUK-based Direct Travel Insurance has published an infographic that aims to bust some popular travelling myths as well as offering an insight into the most popular destinations for UK holidaymakers, the busiest airports and the airlines with the longest delays. One of the myths busted is that passengers are likely to die in a plane crash – in fact, statistics show that over 95 per cent of travellers involved in an air crash make it out alive, and travellers are more likely to die from a bee sting than an air accident.The infographic shows that the top destinations for passengers leaving British airports are revealed to be Spain and the US. Germany was the third-most-popular destination, ahead of countries that are sometimes considered to be more frequent holiday destinations such as Italy and France. Heathrow was shown to be the UK’s busiest airport, with nearly 69 million passengers using the airport each year – more people than currently live in the UK itself. Gatwick, London’s second airport, saw less than half that number of passengers fly from its gates.Moving on to delay statistics, Thomas Cook Airlines Ltd took the top spot with their planes being delayed by an average of 22 minutes. British Airways was on a par with Ryanair (not often that can be said! – Ed) with delays of around 11 minutes.

Chinese dominate Thai marketThe Tourism Authority of Thailand (TAT) has reported that China is poised to become the largest source market for outbound tourists to Thailand, with figures showing that over one million Chinese tourists visited the country in 2010, and the hope is that the number reached 1.4 million in 2011. Further statistics from the TAT have shown that between January and May 2010, the top-five Asian source markets for Thailand were China, Japan, Korea, Hong Kong and Taiwan.The aim of the TAT is to further increase the number of Chinese visitors it welcomes, and to this end, the organisation is planning a series of marketing activities as well as relaxing visa requirements.Jarrat Beaumont, group sales director of Castlewood Group, a commercial real estate developer based in Singapore, commented on the rising tide of Chinese tourists: “More Chinese nationals are travelling overseas as they become more affluent due to the growing economy in China. Thailand has long been a popular destination for them because of its close proximity to China. They also enjoy the idyllic lifestyle and white sandy beaches in Phuket, Koh Samui and Krabi.”

2011 proved to be another strong year for the Dubai tourism sector, with hotels reporting high numbers of guests, guests nights and average length of stay throughout the year. Those already positive numbers were further supported by cruisers, who stop regularly in the Dubai port and disembark to enjoy the shopping and sights Dubai has to offer. According to the Dubai Department of Tourism and Commerce Marketing (DTCM), the impressive performance seen in the Emirate in the face of global economic trouble is testament to the success of its aggressive marketing techniques.Khalid bin Sulayam, director-general of the DTCM, commented on the results: “We have been successful in boosting the number of tourists to Dubai due to our initiatives to enhance our position in established markets and tap new and emerging tourism source markets. The substantial gains by hotels and hotel apartments reflect, once again, the vibrancy and dynamism of the tourism industry

in the emirate.” He added that the start of 2012 had continued the marketing effort, with particular attention paid to the tourism markets in Australia and New Zealand – both nations of avid travellers.The exact figures from the DTCM show that Dubai hosted 9.3 million hotel guests and cruise passengers in 2011, a rise of 10 per cent on 2010. Guest nights rose 23 per cent year-on-year to 32,848,190 in 2011. Meanwhile, the average length of stay increased by just over 12 per cent to 3.6 days. Hotel revenues were high in 2011 at AED16 billion – a rise of 20 per cent over 2010. The majority of the revenue came from hotels themselves rather than hotel apartments, which also gained in popularity. Such increases are more impressive when it is taken into account that there was a five-per-cent increase in the number of hotel rooms on offer in Dubai over the course of the year.Regarding source markets for the Emirate, statistics showed that Saudi Arabia is the top source market, followed by India, Iran, the US, Germany, Kuwait and Russia.

Data published by the Statistical Office of the Republic of Slovenia (SORA) shows that in 2011, the country enjoyed a seven-per-cent increase in the number of tourists it welcomed. The number of nights the tourists stayed also rose by as much as nine per cent in some areas of the country, showing that compared to elsewhere in Europe and in fact the rest of the world, Slovenia is seeing above-average tourist gains. Accommodation facilities that have more than 10 permanent beds recorded tourist numbers of nearly 3.2 million, a seven-per-cent increase on 2010, with most of the tourist arrivals – nearly one million – coming from Italy. The SORA noted that it was particularly pleased that it has witnessed significant growth in the number of tourists who are still choosing to go to Slovenia from traditional markets – there

was a 13-per-cent rise in the number of German holidaymakers, for instance, while Austrian visitors recorded a 10-per-cent increase from 2010. Other, newer source markets also showed their strength and potential for the future, with 27 per cent more tourists from Russia, 18 per cent more from the Benelux countries, a 14-per-cent increase in the number of Hungarian tourists, with smaller increases seen from Croatia, Serbia, the UK and Ireland. Asian countries also proved to be more important than in previous years, with the region as a whole sending 51 per cent more tourists to Slovenia in 2011 than in 2010.The Bank of Slovenia has confirmed the financial boost generated by the tourists in 2011, reporting that the tourism sector earned c2.2 billion for the first time ever – a 10-per-cent increase on 2010.

Once again, backpackers and gap year travellers are voting with their feet, and 2012 looks like it will be a positive year for tourism in South America. According to a survey at the recent UK TNT Travel Show, South America was voted as the most desirable destination by 18 to 35-year-olds heading out on backpacking holidays. Many travellers reportedly chose the destination due to its vibrant and varied history, geography and people.

Kevin Ellis, chief executive of TNT, commented: “Backpackers are streaming everywhere from the Amazon to the Andes to grab a bit of the region’s awe-inspiring culture, history and scenic show stoppers.”Participants in the travel show were asked about their plans for holidays in 2012, which showed that 60 per cent of respondents to the survey said they planned to explore more of continental Europe this summer, with France and Spain coming top of the list of places to visit.

Lake Bled, Slovenia

Slovenia sees tourism gains

South America proves popular

Dubai flying high

THE INTERNATIONAL TRAVEL INSURANCE CONFERENCEPRESENTS…

JOIN US

COMPERE:

Stephen Grant

Comedians:

Geoff NorcottAddy Van Der Borgh

Dinner menuPrawn Cocktail • Chicken (not) in a basket • Jelly and ice-cream

THE INTERNATIONAL TRAVEL INSURANCE CONFERENCEPRESENTS…

JOIN US

COMPERE:

Stephen Grant

Comedians:

Geoff NorcottAddy Van Der Borgh

Dinner menuPrawn Cocktail • Chicken (not) in a basket • Jelly and ice-cream


IPMI NEWS20

come and join usFind us on Facebookwww.itij.co.uk/facebook

Follow us on Twitter @itijonline

Join our LinkedIn groupwww.itij.co.uk/linkedin

International health insurer Allianz Worldwide Care has developed a new dormancy option in collaboration with Pacific Prime Insurance Brokers Co. Ltd. This new plan feature, called Freedom, will be available to all private individuals selecting one of Allianz Worldwide Care’s international health insurance plans through Pacific Prime. Freedom allows the policyholder to freeze their own personally funded health insurance plan if they become eligible for an employer-funded plan, with the ability to re-activate it up to five years later. This option will also be helpful to those who have to be enrolled in a national healthcare scheme due to regulatory requirements in certain countries.While medical treatment is not covered while the plan is dormant, re-activation of the plan will incur no additional underwriting or require any new application forms to be filled in, regardless of whether any new medical conditions have arisen during the dormancy period. Policyholders will pay only 30 per cent of the full annual premium during

each year of dormancy.Susan Landers, Allianz Worldwide Care’s head of marketing and client management, commented: “We are delighted to work with Pacific Prime on

this innovative new service, which brings flexibility and convenience to our mutual clients. As a fresh and pro-active approach to improving the client experience, it is very much in line with our ethos of continuous product and client service improvement.”Neil Raymond, chief executive of Pacific Prime, added: “The introduction of an option which allows policyholders to freeze and then re-activate their international private medical insurance (IPMI)

represents a significant step forward within the IPMI market. Expatriates may change employers up to six times over a 15-year period and their health insurance situation will also change, depending on their employee benefits package and location. This new option recognises this and supports clients during these changing circumstances.”

AXA introduces MyGlobeAXA PPP International has introduced a new online service to support members of its health insurance schemes. From Afghanistan to Zimbabwe, ‘MyGlobe’ provides a wealth of information on 247 countries – helping members to find their feet in unfamiliar surroundings.Should they need medical treatment, members can access information on AXA PPP International’s global network of 10,000 healthcare providers, where, for ease of reference, facilities are listed by country, city and speciality. MyGlobe also identifies facilities where English is spoken, providing an extra assurance to members who may not be conversant in the local language.Additionally, MyGlobe features practical information on local culture and daily life such as public holidays, travel and transport as well as details of embassies, emergency numbers and safety and crime, as well as incorporating special security alerts if significant trouble erupts.Members can also find out about vaccination requirements and local healthcare, including health alerts on communicable diseases prevalent in their destination country, giving them a head start on keeping well while they are on their expatriate assignment or business travels.

Clements Worldwide looks to Latin AmericaInternational private medical insurance (IPMI) provider Clements International, which has offices in the US and UK, has announced its intention to expand its focus to Latin America, and is seeking to open further offices in Brazil and Argentina.Vice-president of the company Dan Tuman

told LatAm Insurance Review that as international businesses recognise the potential in the Latin American marketplace, so the opportunity for providers of IPMI to expatriates increases. He added: “The insurance community in Latin America is relatively small, at about $90 billion of insurance premium in 2010, which is only 2.5 per cent of the global insurance market, and Brazil represents 41 per cent of that total. We expect, overall, Latin America to grow substantially in the coming years, with Brazil continuing to lead the pack. The two major international events coming to Brazil – the Olympics and the World Cup – will attract more attention and investment to Brazil, drawing more expatriates to relocate there.”

US-based UnitedHealthcare has recently released Health4Me, a mobile phone app that brings important health information straight to the fingertips of its plan participants. Available for the iPhone already, and with an Android version coming soon, the app provides 24/7 access for clients to a registered nurse, allows them to locate an in-network physician or hospital near to them by using the GPS functionality of the phone, and gives quick access to their personal health benefit information.

An added-value feature on the app, Easy Connect, lets users choose the type of questions they may have about their benefit and claim limits and also request a call-back service from the company.Policyholders with the app can download their health plan ID card to their smart phone, and email or fax the ID card directly from their device to an in-network hospital or doctor’s office. They can also save their favourite healthcare providers within their network, and record personal notes from a doctor’s visit.

In line with many other companies around the world, international private medical insurance (IPMI) company InterGlobal has placed its growth focus firmly on the Asian marketplace. In order to achieve its aims, the company has strengthened its business development and operational teams in Asia with a number of senior promotions. Tony Valin has been appointed as regional operations manager in Asia, while Alistair Dickman has been appointed as country manager in Singapore. Tony joined InterGlobal in 2005 as country manager for Thailand before taking up the role of country manager of Singapore in 2009. Alistair has been with the company since 2008 and has been heading up business development for the Southeast Asian region.

In addition, Chris Campbell, who was already country manager of Japan, has had his area of responsibility widened to cover Hong Kong and the Philippines. Edlina Ahtarini, sales operations manager, has also had her area of responsibility widened to cover the whole Asian region.Steve Conway, regional general manager for Asia, said: “Asia is one of the most important regions for InterGlobal. Its economic strength and strong growth is attracting businesses and expatriates of many nationalities, all of whom need access to high-quality IPMI. By further strengthening our team in Asia we are able to continue to grow, while maintaining the high standards of personal service and operational excellence that have become the hallmark of InterGlobal.”

Jelf offers online assessmentJelf Employee Benefits (Jelf) has announced that it is launching a new online tool aimed at employers to find out just how confident they are when it comes to international healthcare for their employees. The tool covers key aspects of international health cover and will give employers an immediate indication as to how confident they are in their international healthcare provision. Employers can then download a written report based on their input. The company said the tool’s introduction came because it has discovered that there is a great lack of knowledge and a lot of misunderstanding when it comes to employers purchasing international healthcare, particularly regarding whether they’ve purchased the most appropriate cover at a competitive price. The interactive online tool will ask about a number of areas, including how confident they are that their policy meets the legal requirements of the countries where their employees work and travel, and whether or not they fully understand the exclusions.At the same time, Jelf is also launching a brand new microsite with the objective of providing tightly focused, user-friendly information on the key aspects of international private medical insurance to companies that either have staff working abroad, or are considering sending staff abroad. It is in plain English and is designed to demystify the complex world of international healthcare. It also offers access to a specialist international team of eight at Jelf Employee Benefits who deal solely in international healthcare for both employers and individuals. Sarah Dennis, international healthcare director for Jelf Employee Benefits, said: “A lot of advisers dabble in international healthcare and we come across many employers that are just not aware of exactly what they need and what they have actually bought in the way of international health cover. The online assessment tool is specifically designed to quickly highlight for employers the key areas they should be considering when looking to cover their international employees. Legislation is complex and constantly changing in this area and it’s imperative that employers have the most appropriate advice and guidance; our microsite is clear and easy to use and is a useful first port of call for employers.”

Health4Me offers instant access

Susan Landers

InterGlobal increases Asian focus

AWC launches dormancy option

www.itij.co.uk

21IPMI NEWS

UK-based JLT Benefit Solutions Limited (JLT) has launched the first phase of its global website for BenPal, its international benefits management system. With the platform now live in different regions around the world, further expansion in Asia, Europe, the Middle East and Africa

(EMEA) and Latin America is also planned for 2012.

Duncan Howorth, international chairman of employee benefits at JLT, said: “To complement the international deployment of our BenPal proposition and technology, we have built a new website with local language and content. In this first phase, there are specific sections for the countries where BenPal is now live – UK, Ireland, Brazil and Australia – and we will include more territories as we deliver on our plans for BenPal to be the unifying technology across the JLT International Network of employee benefit consultancies.”Since its launch in the UK in 2009, BenPal now has over 100 clients with recent new appointments coming from outside the UK from companies

operating in multiple countries, including Hitachi and Equifax. Howorth added: “The relative importance of the core components of a corporate benefits package varies from country to country. Whilst pension schemes are a key focus in the UK, health and risk schemes often have a higher priority elsewhere. BenPal is built to manage a wide range of benefits, according to each client’s requirements in each country.”As well as offering relevant content, news and case studies, the website also provides online access to the BenPal secure site for employees whose companies have selected JLT to manage their benefit programmes.Cigna announces

relocationGlobal health service company Cigna announced recently that it is relocating the European headquarters of its International Health, Life & Accident (HL&A) business from Madrid, Spain, to London, UK, and has appointed Alistair Hardie, chief executive of FirstAssist Insurance Services, to the role of CEO, Europe Cigna HL&A. Hardie will be responsible for driving Cigna’s HL&A growth strategy across Europe following its acquisition of FirstAssist Insurance Services. Madrid, though, remains a key country office.The move to London, widely regarded as the European insurance capital, is another important step in the company’s European growth strategy. HL&A now operates in seven European countries: the UK, Spain, Portugal, Italy, Germany, Sweden and Norway, and with the UK serving the lion’s share of over three million customers, primarily through affinity partners, the acquisition signals a shift in Cigna’s European presence.The acquisition in November 2011 has seen Cigna add travel insurance to its portfolio of products, drawing on the extensive expertise of FirstAssist Insurance Services, which now has access to a broader range of health, life and accident products to offer to existing clients, whilst drawing on the extensive international expertise that Cigna brings.Hardie said he is already seeing the benefits of the newly formed business take shape: “The purchase has triggered strong interest from our existing affinity partner base in the UK and has generated enquiries about FirstAssist Insurance Services’ new capability in dental, term life and critical illness products. At the same time, Cigna is already responding to significant interest in travel insurance from several continental European partners.”He added: “We are well positioned to grow our business at a time when the need for health, life and accident products is set to increase as millions of Europeans look to supplement the ever increasing gaps in state provision being created as a consequence of the tough austerity measures being implemented across Europe.” Hardie concluded: “I am excited by the opportunity to lead Cigna’s European operations to the next stage in their development. My key focus will be to leverage the combined expertise of FirstAssist Insurance Services and Cigna for the benefit of our clients, so that they can take full advantage of the changing and turbulent market conditions across Europe with propositions that offer their customers better financial security and wellbeing.”In related news, Cigna has announced plans to extend its coverage of mental health conditions across its product range. The extension means that policyholders will benefit from increased psychiatric care, addiction rehabilitation programmes and online cognitive behavioural therapy. Kirsty Jagielko, head of product management at Cigna, said: “The most appropriate and effective means for treating mental health conditions is in most cases within the outpatient setting via cognitive behavioural therapy, so we’re delighted to now be able to offer a full refund for appropriate treatments. These are conditions that benefit from a blended approach of inpatient, day case and outpatient treatment, so it was important to reflect that in our new inpatient benefit limit.”

JLT’s BenPal website up and running


22 AIRAMBULANCENEWS

Skyservice fleet renewal underway

Simulator moves for ADACGerman company ADAC Air Ambulance has announced that all EC135 and EC145 full-flight-simulator variants at the ADAC HEMS Academy are now in service, following the certification of the EC135 electronic flight instrument system (EFIS) cockpit on 23 February.At the academy in Bonn Hangelar, high-quality simulator training solutions are created, with two full-flight simulators in a state-of-the-art facility, said ADAC. Enhancing clients’ safety and efficiency, the new certification means there is now an even broader choice to fulfil the training requirements: an EC135 with analogue cockpit; an EC135 with digital cockpit; and an EC145 – the first and only EC145 full-flight-simulator in the world, said ADAC.The international and interactive training centre is available for all EC135/EC145 operators, flight training organisations and helicopter pilots.

ECMO service completes 2nd yearAirMed International, an Alabama-based air ambulance company, has announced the completion of its second year of highly specialised ECMO transports. AirMed continues to be one of only a handful of air ambulance programmes in the world capable of ECMO transport for both paediatric and adult patients. Extracorporeal Membrane Oxygenation, or ECMO, is a complicated life-saving treatment similar to a heart-lung machine.“We have received a tremendous response from the medical community across the country at the growth of our ECMO programme and the level of care and safety that we provide each individual patient,” said AirMed’s Mike Key, director of business services. “We are honoured to be a crucial resource to the ECMO community and to play a small part in delivering these critically ill patients to life-saving facilities.”The basic framework of ECMO involves removing the blood from the patient, oxygenating it outside of the body (removing the carbon dioxide and adding oxygen), and then replacing it back into the patient. On its fleet of medical aircraft, AirMed has the capability of transporting ECMO patients and their complicated equipment from one hospital to another’s critical care programme. In conjunction with teams from ECMO Advantage, AirMed’s medical staff undergo extensive ECMO training in order to treat patients whose conditions include both congenital and acute cardiac and respiratory failure.

A pilot working for Kingfisher Airlines has hit the headlines in India for refusing to take a seriously ill 18-month-old child in need of medical treatment onboard his aircraft. As a result of the pilot’s refusal, the parents of the child had to endure a much longer transfer in an ICU-equipped ground ambulance from Kasargod to Bangalore. The treating doctors in Kasargod had requested the airline transfer the child, and had reportedly obtained all the necessary clearances and documentation to support the transfer, but in spite of these being presented to the pilot, he refused to board the child.Ziauddin Ahmed, who was liaising with the family and the airline, confirmed that all necessary permissions had been obtained, and medical certificates produced, but the pilot was unwilling to accommodate the

child and the oxygen cylinder that was essential for continued medical treatment during the flight. Ahmed added: “The airline later refunded the ticket amount and we returned to hospital on the advice from the doctor, keeping in mind the child’s safety.” Kingfisher Airlines suggested that another carrier, which had a flight leaving for Bangalore later on that same day, could be willing to take the child. However, the doctors felt it was too risky for the child, in case a similar situation occurred, and therefore the decision was taken to transfer the child in a specially equipped ground ambulance.

Kingfisher pilot refuses to carry childSkyservice Air Ambulance, a provider of fixed-wing international air ambulance transfers, has announced the arrival of its first new aircraft in its fleet renewal scheme. Chairman of the company Russell Payne, along with his team, decided to replace the fleet of Learjet 35 planes with the Learjet 45XR. The company said: “The Learjet 45XR has the latest flight management system and technology, as well as offering additional passenger comforts such as an onboard lavatory, additional luggage space and seating for a family member onboard. The aircraft is also equipped with dual stretcher

capabilities.” Payson added that the purchase of new aircraft shows the level of support the company receives from its board of directors.

The new Learjet 45XR Skyservice

NEWSWIREConsistent with EURAMI minimum aircraft requirements, AirMedical Ltd in the UK has announced it is withdrawing its unpressurised piston aircraft, a Piper Seneca, from service. The company said it has seen a dramatic decline in demand for air ambulance services using such aircraft from international assistance companies.

A CareFlight NSW (Australia) crew onboard a King Air aircraft recently located four people who were clinging to their upturned fishing boat after it capsized. The crew circled the four people for around half an hour until a Customs aircraft arrived and a rescue boat from nearby Nhulunbuy reached them and picked them up.

US-based Mercy Jets announced that in honour of Heart Month, in February, it would donate twice the usual amount it gives to non-profit organisations, all of which would go to several heart-related charities.

US-based EastBridge Investment Group has signed a consulting agreement with International Air Medical Services, Inc. (IAMS) of Arizona, US, to assist the company in becoming listed on the US Stock Exchange and expand its business into China. IAMS provides long-range jet services for patients who need inter-city transfers within the US.

Flight For Life of Colorado, US, has added a Learjet 35 to its fleet, to fly sick or injured patients further for medical care than it would otherwise have been able to with its other planes, which are King Airs. The aircraft is operated by Mayo Aviation.

www.itij.co.uk

AIRAMBULANCENEWS 23

Medical AirExpress teams up with Cinco AirOn 1 February, two California-based air ambulance providers, Medical AirXpress (MAX) and Cinco Air, finalised a strategic partnership agreement and announced plans to jointly provide full service air medical transport services. The wider plan includes developing similar strategic alliances with Latin American air ambulance operators in order to develop a network of providers of air ambulance services.MAX founder and president Manny Nunez said: “MAX is not an air ambulance broker. We have partnered with Cinco Air to provide consistently superior services at competitive prices. With Cinco Air as a partner, we have a mini-fleet ready to go at a moment’s notice; our equipment and supplies are at the hangar, and on-call flight crews that can be onboard within an hour.” Ray Quinto, president of Cinco Air, added: “Manny has some great ideas and great contacts. He knows the medical aspect and I am the aviation guy. We don’t step on each other’s toes.” Cinco Air has four planes, two of which are currently medically configured and equipped, which will be available for both domestic and international air ambulance transports, equipped and staffed by MAX crew.

In early February, a house fire in the city of Lviv, Ukraine, left just three survivors – siblings aged two, 11, and 13 – their parents, grandparents, and other siblings were all killed. MedFlight911 Air Ambulance, based in Phoenix, Arizona, US, worked with an international team of medical providers, the Red Cross, and diplomats from both countries, to arrange transport for the survivors

When MedFlight911 received a call from a Massachusetts doctor about three young burn victims in the Ukraine who needed emergency air medical transport to Shiners Hospital in Boston, there wasn’t any question about whether or not to take the job. “This was a heartbreaking case,” says Medflight911’s chief executive officer (CEO) William Dee McCluskey. “It was also one of the most complicated transports I’ve ever been involved in.” The children were the only survivors of a devastating house fire that had killed almost their entire family. All three were in a hospital in Lviv, Ukraine, but because of the severity of their injuries and the limited medical facilities available in their home country, they needed to be moved as soon as possible to a specialised hospital capable of treating paediatric burn patients.MedFlight911 worked together with doctors and officials in the US, Ukraine, and Canada to begin the process of transporting the three children to the hospital in Boston. “You had resources of three countries involved, and the politics of the situation were very intense and emotional,” says McCluskey. Sadly, two of the children were so severely injured that they died before the final details of the transport were arranged. However, MedFlight911 was able to work with the doctors in Ukraine to complete the complicated transfer of the 11-year-old boy, who had burns over 99.5 per cent of his body. The journey involved stops in multiple countries, including Scotland, Iceland, and Canada, and hazardous weather conditions, including temperatures that dipped to -26°C. Those freezing temperatures presented problems for both the plane, which could not operate in

extreme temperatures, as well as the patient. The hospital staff sealed off hallways and stairwells with plastic sheeting, creating a temperature-controlled tunnel so that the MedFlight911 medical team could safely move the boy from his room to the waiting ambulance. That extra effort was necessary because the cold temperatures could have further damaged the boy’s already delicate skin tissue.Once the transfer to the air ambulance was completed, the patient and crew were ready to begin the trip to Boston. Throughout the 14-hour

trip to the US, the medical crew was focused on keeping the boy as stable as possible. Fortunately, because of the combined efforts of the MedFlight911 team and the others involved in the transfer, the boy made it to the US safely. When doctors at the hospital in Boston took over the boy’s care, they expressed how impressed they were with the level of care the boy had received during the trip.Currently, the boy is in stable condition at Shiners in Boston, where he is accompanied by one of his surviving relatives. “He’s not out of the woods yet, but they’re optimistic about him doing well,” says McCluskey. While this was an extremely complex transfer, the combined efforts of the MedFlight911 team, doctors in Boston and the Ukraine, officials in several countries, and members of the Lviv community who came together to raise the money to pay for the transport allowed

for the boy to get the care he needed and begin the long recovery process. “Because of the efforts of the US doctors and the dedication of a great number of people to this case, this child’s life will be saved,” said Lviv mayor Andriy Sadovyy, in a letter thanking MedFlight911 for its efforts.“While this was a challenging situation, everyone involved was able to work together to find a solution that allowed us to save the life of a child, which is an amazing feeling,” says McCluskey.

High-risk repatriation

The hospital staff sealed off hallways

and stairwells with plastic

sheeting, creating a temperature-

controlled tunnel so that the MedFlight911 medical team could safely move the boy from his room to the waiting ambulance

Hawker Beechcraft Corporation (HBC) and its local distributor, Hawker Pacific, have announced the recent delivery of a fleet of five King Air turboprops to the Royal Flying Doctor Service (RFDS) Eastern Division in Australia. The two King Air 350C (cargo door variant) and three King Air B200C aircraft join a fleet of air ambulance aircraft operated on contract for New South Wales Department of Health. The delivery of the King Air 350C aircraft marks the first of this type into service for the RFDS. “The King Air turboprops are the ideal choice for the Royal Flying Doctors air ambulance missions as they feature large, pressurised, environmentally controlled cabins with high cruise speeds and the payload/range required to expeditiously transport critical-care patients,” said Jay Gibson, vice-president,

special missions and corporate government relations for Hawker Beechcraft. “Additionally, the King Airs are capable of operating from short, unimproved runways, providing additional flexibility during critical situations in the remote areas of Australia.” Elsewhere, the RFDS Queensland section has celebrated the official opening of its new base in Mount Isa. Chief executive officer Nino Di Marco commented: “This is a purpose-built complex with room for expansion and growth of RFDS programmes in the Mount Isa region. It will give us greater flexibility in terms of our service delivery, enabling us to work with the local health and hospitals network and Medicare Local to deliver programmes that meet the needs of those living, working and travelling in the North West.”

One of the new King Air aircraft recently delivered to the RFDS Hawker Beechcraft

NEWSWIREConsistent with EURAMI minimum aircraft requirements, AirMedical Ltd in the UK has announced it is withdrawing its unpressurised piston aircraft, a Piper Seneca, from service. The company said it has seen a dramatic decline in demand for air ambulance services using such aircraft from international assistance companies.

A CareFlight NSW (Australia) crew onboard a King Air aircraft recently located four people who were clinging to their upturned fishing boat after it capsized. The crew circled the four people for around half an hour until a Customs aircraft arrived and a rescue boat from nearby Nhulunbuy reached them and picked them up.

US-based Mercy Jets announced that in honour of Heart Month, in February, it would donate twice the usual amount it gives to non-profit organisations, all of which would go to several heart-related charities.

US-based EastBridge Investment Group has signed a consulting agreement with International Air Medical Services, Inc. (IAMS) of Arizona, US, to assist the company in becoming listed on the US Stock Exchange and expand its business into China. IAMS provides long-range jet services for patients who need inter-city transfers within the US.

Flight For Life of Colorado, US, has added a Learjet 35 to its fleet, to fly sick or injured patients further for medical care than it would otherwise have been able to with its other planes, which are King Airs. The aircraft is operated by Mayo Aviation.

RFDS receives King Airs


24 AIRAMBULANCENEWS


26 FEATURE

As cruise ships get ever larger and embark on ever more ambitious itineraries to more distant seas, what are the implications for medical

assistance companies?

This year did not start well for the cruise industry. Were 2012 not the centenary of the world’s most infamous maritime tragedy, the media spotlight on the capsizing off the Italian coast of the cruise ship Costa Concordia on Friday 13 January might have been a little less intense. But a frenzy of comparisons with the sinking of the supposedly unsinkable Titanic on its maiden voyage 100 years ago was inevitable.“It was just like the Titanic!” trumpeted the headlines. No, it wasn’t. The Concordia ran aground within sight of land and rescue was quick to arrive. Some survivors even swam ashore. Of a complement of 4,200 passengers and crew, fatalities were put at 32. Each such death is, of course, a tragedy. But when Titanic went down in the early hours of 15 April 1912, 375 miles out into the North Atlantic, the toll was 1,517 lost out of a complement of 2,223 passengers and crew. The fate of Titanic did not spell the end of transatlantic liner travel. It took two world wars and the advent of affordable air travel to do that. Concordia’s mishap seems equally unlikely to deter many from taking an ocean voyage.

The only way is upOn the contrary, cruising is increasing in popularity. In the UK alone, the cruise market has more than doubled in the past decade, reaching 1.62 million passengers in 2010 and set to reach 1.7 million in the near future. At the annual convention of the Cruise Lines International Association (CLIA), industry leaders representing 26 of the world’s largest lines predicted they would carry more than 17 million passengers in all this year – a five-per-cent year-on-year increase. New ships are coming down the slipway, too, with 14 cruise vessels to be launched this year and 10 more by 2015. And while the majority of cruises still operate in the familiar waters of the Caribbean, the Mediterranean and the Atlantic, a growing number of ships now sail the Pacific, the Indian Ocean, the South China Sea and – perhaps most challenging of all from the medical assistance standpoint – the freezing seas of the Antarctic and Arctic regions. With new products such as all-inclusive holidays, cruising is no longer perceived purely as a pastime for the wealthy, but as an affordable holiday offering value for money. In the UK, Southampton is probably the most popular port of departure for these cheap, short cruises. Vessels are rarely far from European soil, so this type of cruise arguably poses no more problems for travel insurers and assistance companies than a typical

package holiday. Similarly, from the US, most short cruises – typically only three or four nights long – operate out of Miami and Fort Lauderdale to the Bahamas and back, so vessels are never far from the US mainland. That said, there is also healthy demand for ‘ultra luxury’ cruises, with cruise lines responding to the economic downturn by bundling added value elements – such as travel insurance, drinks, excursions and tips – into the price.And the ships are getting bigger. Royal Caribbean International’s (RCI) sister ships Allure of the Seas and Oasis of the Seas, launched last year, are the world’s largest, each with space for 6,296 passengers, but there are currently at least 30 vessels with a capacity of 3,000 or more, and at least 16 ships with space for 2,500 to 4,000 people are currently under construction. The sheer size of these floating cities must make minor and major medical emergencies onboard statistically more likely than on smaller vessels. As numbers and itineraries expand, passenger profiles are changing too, as cruise lines succeed in attracting a younger clientele. According to the Passenger Shipping Agency (PSA), which speaks for the cruise industry in the UK, the average age of the UK cruise passenger is a sprightly 54, brought down by a growing number of families with children. However, cruising still attracts a very substantial number of older

clients. According to Dr Kate Bunyan, medical director of Carnival Cruises, 33 per cent of UK cruise passengers are over the age of 65. This in itself poses some challenges for cruise lines and for insurers. Relatively few cruise passengers travel solo – mainly because of the high cost of a single-occupancy cabin. Onboard medical and service staff are usually aware of the need to keep a tactfully close watch on older solo travellers in case of health problems, and cruise lines normally use pre-departure screening questionnaires to help identify and meet the needs of passengers with details of necessary medication, existing health issues or mobility problems, but Dr

Cruising for a bruising

The sheer size of these

floating cities must make

minor and major medical

emergencies onboard

statistically more likely

than on smaller vessels

www.itij.co.uk

FEATURE 27

Bunyan notes that these are only useful if completed fully.“Booking terms may state that insurance is a must, but it is often not feasible to confirm accuracy,” she says. Onboard, particular challenges include medication that is forgotten or deliberately not taken, multiple co-morbidities that increase the change of a medical emergency, and above all a limited resource environment – these ships are designed to offer emergency medical management, not long-term care.The CLIA requires its members to comply with American College of Emergency Physicians (ACEP) levels of care, with medical facilities staffed by trained and licensed medical staff with at least three years of clinical experience, including minor surgery and emergency care. Many ships are now incorporating telemedicine, with onboard doctors using new technologies to communicate with specialists on land.Several Caribbean islands – including Guadeloupe and Martinique, which are French ‘overseas departments’; St Martin and St Barthelemy, which are French ‘overseas collectivities’; and Aruba and Curaçao, which are part of the European Union (EU), and that therefore means visiting EU nationals holding a European Health Insurance Card are entitled to the same level of care as local residents. In addition, the UK has reciprocal healthcare agreements with former British islands including Anguilla, the British Virgin Islands, Barbados, and Turks and Caicos. Standards of private and public medical provision vary widely across the Caribbean nations, with US-administered Puerto Rico, the larger French-administered islands, and former British territories such as Jamaica, Trinidad and Barbados generally offering adequate standards of care in private hospitals and clinics. Mexico, too, has adequate private hospitals in cruise ports and resorts such as Cancún (and in most ports of call on its Pacific coast), so airlift to the US is not always an automatic first option for assistance companies, says Adam Hvid, operations manager Denmark, SOS International. “Depending on where in the Caribbean the injured party might be, different evacuation possibilities present themselves as ‘preferred’. We co-operate with hospitals in Mexico and in Venezuela that provide the care needed, securing costs and quality,” Hvid says. At the other end of the scale, Haiti’s health infrastructure does not meet international standards, and some of the smaller and less prosperous island nations have only limited hospital facilities. In part, this is a result of the Caribbean’s proximity to North America: travelling to the US or Canada for treatment has always been an option for better-off island residents. Meanwhile, Mediterranean cruise passengers requiring evacuation and treatment on land have relatively easy access to high-quality private care in EU countries, and can be quickly transferred by air ambulance from ports in North Africa and the Middle East, where high-quality care may be less readily accessible. With wide variations in the levels of care even in Caribbean waters, longer itineraries to remoter destinations – many of them in developing countries where public sector healthcare may be rudimentary and private hospitals are thin on the

ground – create special challenges for insurers. Most of the Caribbean, the inshore waters around the US, the UK and the Mediterranean are well within the range of rescue helicopters such as those operated by the US Coast Guard or Britain’s Royal Navy and Royal Air Force, but even when a vessel is well within the operational envelope of helicopters such as the US Coast Guard’s Sikorsky Jayhawk or Britain’s Sea King, hoisting a patient, sometimes in darkness, from a ship as tall as a 16-storey building and moving at around 20 mph is a risky business. Not surprisingly, such operations are regarded as a last-resort option.More remote destinations (such as Alaska) within developed countries also need different evacuation and repatriation plans. Polar seas, with their extreme weather conditions and vast distances to be covered, create perhaps the biggest challenges of all. Even the familiar transatlantic voyage can pose problems: helicopter evacuation is quite feasible in smaller seas such as the Mediterranean or the Caribbean, but Atlantic cruise ships may be out of the range of evacuation helicopters for most of their journey.A similar issue arises in the South Pacific, according to Kirsty Bell, international operations manager for New Zealand-based assistance company First Assistance. “Every year we see the cruise lines competing with cheaper and cheaper package deals and this is prompting many, especially the retired community, to flock to cruises for their winter breaks. Real issues arise with this as, while most cruise companies encourage or insist on travel insurance, few make clear the pitfalls of exclusions or limitations of the policies – especially the risk of pre-existing medical conditions being declined. This causes serious issues in the event of a medical emergency as the cruise line expects full responsibility to sit with the insurer and their assistance company,” says Bell. “Sometimes this can be life-threatening.”Furthermore, the South Pacific has no medical centre of reasonable size or standard, Bell says, and opportunities for repatriation using scheduled airlines are very limited. “Almost all patients disembarked would require an air ambulance, but as there are no air ambulances stationed in the South Pacific, all missions need to be staged from New Zealand or Australia, causing delays where the patient must be cared for in port.”Bell recalls a case of an Australian passenger being offloaded in Vanuatu, an extremely popular cruise destination with limited medical facilities. “The cruise ship doctor contacted First Assistance to arrange an urgent medevac, only to discover that the passenger’s heart condition had been excluded under their insurance policy, through their pre-travel medical screening. This left the cruise company, and the assistance company, in a predicament of being unable to evacuate the passenger (except at their own cost – which was declined by the patient) and the patient having to remain in a facility with limited care for three days until the next cruise ship arrived in port and re-boarded the passenger. In this case, Bell says, the patient remained stable and was able to safely continue the journey. “This raises serious issues for all parties. It also raises the point that if the patient was able to re-board a later cruise, should

they have been offloaded in the first place?”Bell’s observation is that while the cruise lines often include their extensive medical facilities as part of their advertising, there are no clear standards as to when a patient should be disembarked, or what considerations are undertaken first. Cruising with careAs cruise ships have become bigger and ever more sophisticated, so too have their onboard medical facilities. Typically, large cruise ships offer a wide-range of non-invasive intensive care and diagnostic facilities, fully stocked pharmacies, cardiac monitoring and defibrillation equipment, and staff trained according to ACEP guidelines. For example, RCI’s Allure of the Seas and Oasis of the Seas each have three doctors and five nurses offering round-the-clock emergency services. Through telemedicine and the line’s affiliation with the Cleveland Clinic in Weston, Florida, the

onboard team can also offer 24-hour consultation in a variety of areas, and all RCI’s Radiance-class, Voyager-class, Freedom-class and Oasis-class vessels have dedicated medevac helipads from which critical cases can be airlifted up to 150 miles offshore. Writing in The Trauma Professional’s Blog, Dr Michael McGonigal, director of trauma services at the Regions Hospital in St Paul, Minnesota, says he is impressed by the Allure’s medical centre and its staff. “They are also in tune with the capabilities of the hospitals in the various ports of call and have well-thought-out procedures [regarding] who can be taken care of on the ship and who needs to be transferred ashore,” he notes. At the other end of the size scale – and on the other side of the world – smaller cruise ships (most of them carrying no more than 100 passengers) operate in the extreme conditions of Antarctica. Here, the extreme climate and long distances from departure ports create some

while the cruise lines often include their

extensive medical facilities as part of their

advertising, there are no clear standards as to

when a patient should be disembarked, or what

considerations are undertaken first


28 FEATURE

special requirements. Steve Wellmeier, executive director of the US-based International Association of Antarctica Tour Operators (IAATO), points to a clear divide between smaller ‘expedition’ vessels that carry from 12 up to 500 passengers and that land their passengers on the Antarctic continent by infl atable landing craft, and larger, conventional cruise ships whose passengers must stay onboard and that do not venture so close to land. Expedition vessels, Wellmeier says, normally carry a medical doctor and have an onboard medical suite, and their operators typically require all passengers to have at least US$250,000 of emergency medical and evacuation/repatriation coverage. Medevac from King George Island, in the South Shetlands archipelago, the nearest airstrip to Antarctica, is usually handled by air ambulance from Punta Arenas, in southern Chile. “When a passenger’s medical requirements are more than can be handled by the physician aboard, the expedition ship will usually divert to King George Island and transfer the passenger to the airstrip, where they are expected and the ambulance service has been notifi ed,” Wellmeier says. “Th ere is a limit as to medical equipment and staff that can be carried aboard a small expedition ship carrying 85 to 200 passengers, but those procedures work quite well. IAATO members also share a contingency plan, outlining procedures and protocols of assistance to one another in emergencies.” Expedition ships must also be more rigorous when screening passengers for pre-existing medical conditions and special medical needs before departure, Wellmeier says, requiring all passengers to have a certifi cate of health from their own physician. “Occasionally, passengers are turned down if the vessel operator feels the pre-existing conditions might cause a problem.” Larger cruise vessels venturing into polar waters, Wellmeier says, normally have medical facilities and staff that are quite capable of handling emergencies for the medium term, even in Antarctic waters. “Really, how is Antarctica any diff erent than being in the middle of the Atlantic, where there is nowhere to go? Th e larger ships are prepared for this.”

Clash of opinionWorldwide, once a customer in need of medical care has been disembarked – whether by emergency helicopter, or at the vessel’s next port of call – there is the risk of a clash between travel insurers, cruise lines, medical assistance companies and indeed the patient’s own wishes. Th e cruise line’s fi rst priority is likely to be keeping the vessel on schedule, and that rules out delaying departure for the next port of call, even for passengers who may be quickly discharged from hospital after treatment for relatively minor ailments or injuries. Th ose passengers may well be aggrieved at being left behind, and their cases and claims need diplomatic handling.SOS International’s Adam Hvid says it’s important for assistance providers to be involved from the beginning of any incident. “It’s critical for us to intervene early, on behalf of our clients, the insurance companies,” Hvid says. “Th is is not always possible, but very benefi cial. I’m sure most assistance companies would agree with this point of view.” Carnival’s Dr Kate Bunyan notes that challenges include complaints of abandonment if the cruise company fails to meet the customer’s expectation of quick repatriation. Language and cultural barriers may also become an issue: a major selling point for many cruise passengers (especially older travellers) is the sense of safety and familiarity onboard a vessel that is in many ways a microcosm of home. Being disembarked and hospitalised in a much more alien environment can be traumatic in itself. Meanwhile, hospitals and clinics in some popular ports of call stand accused of over-treatment to maximise their own revenue. In some cases, according to Dr Annette Girad-Claudon, medical director of International West Indies Assistance, hospitals may resist repatriation, and it may even be easier to evacuate from a cruise ship than from a medical facility on land.Ensuring a smooth handover of responsibility at each stage – disembarkation or medevac, hospitalisation, repatriation and swift settlement of claims – can be key to the process. Just as the most dangerous time for a diver is not deep underwater but on the surface, the critical time for all parties involved in resolving cruise

passenger insurance issues is not far out at sea but at the interface between ship and shore care.Th e key to successfully managing a medical emergency on the cruise ships, according to Kirsty Bell, is to involve the insurer and the assistance company doctor as early as possible. Many cruise lines have port agents who will arrange the disembarkation, but if the insurer isn’t involved in the decision making this is going to cause delays, as well as stress and risk for the patient. “Open communication from the start between our doctor, the ship’s doctor and the patient can result in a much more favourable outcome”. Bell recalls cases where cruise ship doctors have disembarked passengers with their own oxygen and medical staff to care for them in ports with poor standards of medical

care. Th e assistance company can facilitate the return and reuniting of cruise ship equipment and staff . Often a ‘ship-to-wing’ transfer can be arranged by keeping the passenger onboard until a port opportunity where the assistance company can arrange them to be transferred directly to a plane, rather than having to overnight in a primitive hospital.Maintaining good relationships with the cruise doctors is also critical. “During the peak cruise season we can see four to six patients disembarked off a single cruise ship,” says Bell. “It gets to the point where my team are on a fi rst-name basis with the ship’s doctor.” As the number of cruise ships increases, this personal relationship between the assistance company and the medical staff of the ships gets harder to maintain, but Bell

says it is the key to working through issues when they arise in an emergency. SOS International’s model could provide a template for assistance companies worldwide. “An increasing number of clients, including maritime companies, are interested in having a plan for how to provide medical assistance and/or crisis management solutions,” says SOS International’s Adam Hvid. “An enhanced co-operation and sharing of information would defi nitely be benefi cial for all parties.”Th e company off ers shipping lines a two-track service that includes a customised report on any given route, identifying the nearest preferred medical facilities, according to diagnosis, based on its SOS Providers Network database. “All eventualities are drawn up and a number of recommendations prepared, so the company would, in the case of a medical emergency, know who to turn to, which port to call upon, contact information, standard of medical facility, and so on,” says Hvid. “Considerations about evacuation recommendations are also included. Th is solution provides a static but detailed view of the company’s needs in any given medical emergency situation.”Meanwhile, SOS World Wise provides web access to SOS International’s Providers Network, off ering access to relevant and up-to-date information needed to address acute medical situations. “SOS World Wise provides much of the same information that a customised report would do,” Hvid says. “Th e diff erence is that it’s dynamic and updated frequently.” Kirsty Bell has the fi nal word. “At the end of the day we are all professionals and have to put the patient fi rst. Th is doesn’t mean that an insurer is going to evacuate a patient who is outside of policy benefi t, or that a cruise ship doctor is going to keep a patient onboard when they feel it’s not appropriate, but open co-operative communication is going to get us the best possible outcome, even when options are limited.” n

As the number of cruise ships increases, this personal

relationship between the assistance company and the

medical staff of the ships gets harder to maintain

19 - 21 June 2012 | Peninsula Shanghai | www.itic.org.uk/shanghai

INTERNATIONAL

TRAVEL

INSURANCE

CONFERENCE

ASIA PACIFIC

THE LEADING GLOBAL

TRAVEL AND HEALTH

INSURANCE CONFERENCE

REGISTERNOW

EARLYBIRDRATES

AVAILABLE

Proud sponsors

hospitals may resist

repatriation, and it

may even be easier

to evacuate from

a cruise ship than

from a medical

facility on land

USCA

19 - 21 June 2012 | Peninsula Shanghai | www.itic.org.uk/shanghai

INTERNATIONAL

TRAVEL

INSURANCE

CONFERENCE

ASIA PACIFIC

THE LEADING GLOBAL

TRAVEL AND HEALTH

INSURANCE CONFERENCE

REGISTERNOW

EARLYBIRDRATES

AVAILABLE

Proud sponsors

New OrleansINTERNATIONAL TRAVELINSURANCE CONFERENCESHERATON NEW ORLEANS HOTEL19-21 MARCH 2012

The ITIC New Orleans Review contains synopses of all the

sessions that were held at the conference. An overview of each presentation offers an insight into the main points that were made by the speakers, highlighting the most salient information and advice from the presentations.Also included is a collection of some of the best photos from throughout the conference, including the Welcome Function, which was sponsored by Baptist Health South Florida, and the Farewell Dinner at Latrobe’s on Royal. For more images of the conference, as well as the chance to download the speaker presentations, simply log in to your Travel Insurers Network (TIN) account. If you don’t already have an account, it is quick and easy to sign up, and TIN enables members to delve deeper into the world of ITIC, including making it easier to network with your fellow past, present and future delegates. For more details, go to www.travelinsurersnetwork.com

www.itic.org.uk/linkedinwww.itic.org.uk/twitterwww.itic.org.uk/facebook

Thank you to all our sponsors

www.itij.co.uk

ITIC REVIEW 31

Ralph Lawson

executive vice-president and chief financial officer, Baptist Health South Florida

Opening the panel on healthcare reform in the US and its direct impact on international insurers and travel insurance, Ralph

proclaimed a belief in the free market and opened his remarks by pointing out that market forces will drive more profound changes to healthcare in the US than the so-called ‘Obamacare’ provisions.The US Government now has an ‘intense focus’ on lowering the unit cost of healthcare,

with an equally strong focus on transparent provider cost performance and availability. An ‘unrelenting focus’ on patient safety and quality must be maintained by the private sector, he said.The US’s private sector is far from immune from red tape, Ralph pointed out, in a presentation that revealed that private sector insurance bureaucracy accounts for 31 per cent of every health dollar spent in the US. Entertainingly, he looked at the flow of information from patients struck by dolphins and turtles, and pecked by turkeys, geese and chickens, from the initial encounter to resolution of the claim.But, Ralph said, visions of huge additional healthcare costs, as predicted by the International Monetary Fund, may be questionable, and the ability of good old-fashioned US know-how to improve quality and lower unit costs cannot be ruled out. Looking at the changes that must occur under the US’s new health regime, Ralph said that one of the key alterations is that there are no longer any ‘revenue centres’ for health insurance. Perhaps most excitingly of all, Ralph opened up the prospect of new ventures in ‘Uncle Sam’s backyard’ – the Caribbean. Without naming names, he pointed to his company’s ‘very aggressive’ proposals to provide all ‘off-island’ healthcare for a Caribbean sovereign state for a fixed fee. But, he also said that creating such ventures would require imaginative partnerships between governments and a range of private sector suppliers.

Kenneth B. Schnoll

attorney, SNR Denton US LLP

Kenneth Schnoll got a laugh from the audience when he pointed out that one of the very few ways for an individual to avoid the ‘individual

mandate’ provisions of President Obama’s Patient Protection and Affordable Care Act (PPACA, or ACA) was to be in prison. Addressing the complex issue of how major reforms to the legal infrastructure of US healthcare under the ACA will impact international insurers and travel insurers, he described the introduction of the ‘individual mandate’ as a radical transformation of the health insurance market within the US and for transnational insurance providers, who may find their ability to market their products within the US challenged by the new provisions.The reforms, he said, are ‘wholly incompatible with travel insurance’, including such provisions as pre-existing condition limitation, coverage of preventative services, and prohibition of annual and lifetime limits. Applicability of the market reforms to a specific plan depends primarily on whether it meets the definition of ‘group health plan’ or ‘health insurance issuer’ and also on whether the plan meets the definition of ‘group or individual health insurance coverage’. If an entity is an insurance company, insurance organisation or insurance service that is licensed to engage in insurance in a US state, it is subject to the reforms contained in the ACA, he said. For ‘alien’ (non-US) companies offering health provision to residents of US states, some of the new legislation poses a number of bureaucratic challenges. Alien companies will have to be licensed in each US state in which they intend to provide cover – and that, said Ken, will be ‘next to impossible’. Key to understanding and adjusting to the new regime will be clarity in defining what constitutes a group health plan under the ACA, and what will be considered to be individual cover. Unless the plan is employer-based, Ken said, it will for all practical purposes be considered as individual. He also pointed out that only health insurance coverage is subject to ACA, and the provision that ‘applicable individuals’ must maintain minimum essential coverage does not apply to ‘aliens’ lawfully present in the US or to US citizens resident outside the US for the full tax year. Members of Native American tribes are also excepted. He then outlined a number of options for compliance with the ACA’s provisions. These

included converting medical coverage into fixed indemnity coverage in accordance with a schedule while travelling. Insurers might also convert travel plans to ‘accident only’ plans, while providing medical benefits under a separate policy or as short term coverage, or could convert each travel insurance plan into a short term limited duration plan with a validity of less than 12 months, renewable only with the consent of the issuer. Finally, the insurance industry might lobby for travel insurance to be added to the list of additional coverages that may be excepted from the market reforms, on the grounds that it is similar in nature to current ‘excepted benefits’.

Healthcare reform in the US

Andres Beltran Fletscher

president and CEO, Emergency Corporation

Andres Beltran-Fletscher opened the panel on medical cost containment and travel assistance in Latin America by looking at some of

the causes for increased expenses claims in the region. His presentation strongly emphasised the need for greater transparency among all partners in the chain, from client, through on-the-ground care providers, to insurance providers.At the top of his list was the issue of ‘false expectations’, where the client has not been

made fully aware of the limits and exclusions of the policy. Andres also spoke of the issue of ‘compulsive users’ who may make claims for treatment while on vacation that would not be fully covered by their medical insurer at home. As a result of this, he pointed out, there has come to exist a culture of increased use of medical services and increased rates by suppliers of such services in Latin American destinations. A major and rapidly expanding component of medical costs, Andres warned, grows from widespread applications of tests and procedures that may be of no relevance to a specific case. Attempting to deal with an endemic culture of over-treatment in Latin American regions may take time. Education, peer reviews, administrative charges, penalties and rewards policies may all play an important part in inducing physicians to participate in cost containment. Most importantly, insurers should seek tools to control losses with hospitals and physician networks. Insurers should also consider strategies including co-payments and deductibles, subrogation, and identifying probable causes and collecting documentation from the start of the case. Andres went on to illustrate how the lack of ‘closed service’ networks, and the continued use of a variety of providers, can increase medical costs. Some potential solutions, Andres said, include direct payment of medical claims – a service that is increasingly sought after and valued by insurance companies. Managing costs like these, he said, effectively involves going beyond basic controls such as restricting access and sharing expenses.

Pablo Castillo

CEO, Medbrick

Pablo Castillo started his presentation on medical cost containment and travel assistance in Latin America by defining the territory: 20 nations,

from Mexico in the north to Argentina and Chile in the south, visited by more than 50 million people a year. And the subcontinent has big ambitions, Pablo said. Brazil led the way with 5.4 million international visitors last year (2011), and expects to double that number during the FIFA World Cup in 2014 and the Summer Olympics in 2016. Peru welcomed 2.5 million international travellers last year, and Colombia wants to build on its peace dividend by attracting four million international tourists in 2014 with the slogan: “The only risk is that you’ll want to stay.” Argentina’s target is eight million international tourists by 2020, building on around five million visitors at present. The leader of the Latin American pack, however, is Mexico, with a record-breaking 22.6 million visitors last year.Defining medical cost containment as ‘the art of reducing the costs of a medical service offered to a person or organisation’ coupled with the act of supporting someone away from home and in need of guidance, Pablo laid out the main challenges for travel assistance companies in Latin America. These include finding trustworthy providers, diversity of facilities and services, and containing costs through direct billing. The Health Insurance Portability and Accountability Act, he pointed out, is simply not applicable in most Latin American countries, and customised billing is rarely available. Bureaucracy is also an issue with air ambulance transfers. However, as Pablo got into his swing, he fluently addressed the myths and the reality of a region that may be united by linguistics but which embraces jungles, deserts, glaciers and icebergs – as well as some of the world’s biggest and fastest growing megacities. Moving back to the bottom line, Pablo addressed the issue of high or low billing, pointing out again that healthcare costs vary hugely in this complex region.

Medical cost containment and travel assistance in Latin America


32 ITIC REVIEW

Shai Gold

managing partner, International Triage LLC

Opening the session on quality and the challenges involved in accessing hospital care in the Caribbean region, Shai

Gold made connectivity the key theme of a presentation that addressed the need for insurance stakeholders to subscribe to an ‘effective management continuum’ embracing the different aspects of an active claim. Defining ‘connectivity’, Shai said it is attained when stakeholders subscribe to an effective management continuum for the clinical, business and customer service aspects of an active claim.Key elements included effective, medically driven case management, real-time provision support, exceptional provider relations and a deep commitment to customer service. Shai then went on to summarise the challenges facing insurers and assistance providers, including the limited availability of common business process management and reporting practices, which can complicate the provider/payer relationship. The lack of local support services, such as independent medical case management, is another serious challenge. Even more importantly, the typical demand for up-front payment from hospitals and practitioners in the region comes as a shock to patients and their companions at a stressful time. In turn, because the consumer perceives the insurer to be primarily responsible, such negative experiences can have an adverse effect on the payer’s brand, ranging from negative publicity through to potential liabilities, legal costs, and waste of executive time. Shai’s presentation highlighted how ‘dream vacations’ in the Caribbean can too quickly become nightmare cases for insurers and their clients. Shai then went on to outline International Triage’s philosophy of solutions and mitigation, which emphasises connectivity between payers, providers and patients in the Caribbean islands and Caribbean countries, using provider agreements that are based on payment guarantees in exchange for ‘unprecedented access and authority to oversee treatment’, ensure optimal cost containment, and protect the payer’s brand. Among the keys to ensuring satisfaction, Shai said, were providing patient support services such as ‘hassle-free’ direct admission to hospitals, access to English-speaking doctors, transportation and translation services, and seamless communication with case managers.

Maria Caceres

director, Seven Corners Assist

Maria Caceres followed up Shai Gold’s presentation with a look at the special circumstances that apply to accessing quality care

for clients in the ‘Caribbean Basin’ – a region which, as she pointed out, embraces some 37 island and mainland nations, divided not only by geography but by language, geopolitics, and economic and cultural ties to former colonial powers and to the US, Canada and mainland Latin America. These range from relatively tiny island nations such as St Kitts and Nevis to more populous states such as Jamaica and Trinidad and Tobago; and to mainland ports of call in Caribbean coastal nations such as Belize, Guyana and Panama. However, for cruise lines, their passengers and their insurance providers, Maria’s presentation provided some more interesting facts: across the Caribbean, and into Central America, there were just 400 medical facilities and ‘adequate care facilities’ were less than 10 per cent of those.Maria’s presentation had to look most closely at care in the region from a US point of view, and she looked at how care in Caribbean and Latin American countries compares with the medical care in the US, through to implementation, cost containment, case management – and

direct payment, a topic that popped up again and again throughout the event.Summing up, Maria said that there are possibilities for ‘win-win’ solutions in the Caribbean context, but that providers need to show an understanding of the region, work to explain to their clients what to expect, and above all build partnerships on the ground with companies who are familiar with local conditions.

Jose Natalio Redondo

founder and president of the Board of Directors, Grupo Rescue Corporation

As one of the most popular destinations in the Caribbean, both for cruise passengers and longer-stay package holidaymakers, the

Dominican Republic has had its share of poor publicity. Jose Natalio Redondo contributed

to the panel on quality and challenges in accessing care in the Caribbean region with a presentation that focused on the challenges of cost control and client satisfaction, alongside lowering non-medical related costs. The main challenge in the Caribbean region and in some Latin American countries, he said, was achieving closer co-operation between insurance companies and healthcare providers and establishing short to medium-term strategies to bring about significant reductions in medical costs. In the long run, he believes, this can generate a sustainable system that prioritises quality service and customer satisfaction – in short, a ‘win-win’ environment for all parties. However, within the current market situation in the region, this can only be achieved by applying these measures to effective reduction of intermediate costs. Grupo Rescue’s solution to this involves combining a team of 469 specialised doctors within seven private clinics in the Dominican Republic’s main towns and busiest resort areas, featuring a one-number, 24/7 emergency response and services that range from outpatient and urgent care clinics to house calls, emergency and trauma hospital services and medical evacuation. However, the most impressive part of his presentation dealt with how insurers can reduce costs, reduce final

bills and increase client satisfaction by avoiding conflicting business chains. Key factors, Jose Natalio emphasised, included a reduction in unnecessary referrals, avoiding late referrals and non-recommended facilities, thorough knowledge of the destination and the local providers’ practice capacities – and, of course, prompt payment to the provider.

Quality and challenges in accessing hospital care in the Caribbean

Welcome Function

www.itij.co.uk

ITIC REVIEW 33

John Rendeiro

vice-president of global security and intelligence, ISOS

You could argue that this was the event’s sexiest presentation – reeking just a bit of camouflage-jackets, desert boots and

testosterone. Perhaps the most striking element of the presentation by John Rendeiro, who opened Tuesday’s session on political risk, disasters and evacuation co-ordination, was the speaker’s most measured approach to this difficult and very contemporary topic.While terrorist-related and criminal offences do affect travellers, only a minority will be directly or indirectly affected, John emphasised. However, in a situation such as the so-called ‘Arab Spring’, specialist evacuation operators will necessarily work in an environment that lacks immediate clarity. John Rendeiro’s presentation looked strongly at command and control structures under stress in such situations. He stressed the importance of imaginative integration, and outlined how Control Risks oversaw the evacuation of 1,500 expats while Gadaffi’s Libya went into meltdown, using a mix of new and old communications media.For contrast, he went on to look at how Control Risks might approach a very different emergency situation – last year’s tsunami and nuclear incident at Fukushima. Advice, he said, along with real-time control of the situation, is still central.

Charlie LeBlanc,

president, FrontierMEDEX Security Services

There’s an old military maxim that no plan survives contact with the opposition. Charlie LeBlanc might have been channelling that

thought with a presentation that summoned up memories of Rudyard Kipling’s ‘If you can keep your head when all around you are losing theirs, and blaming it on you’.Focusing on the tricky issue of evacuation from holiday or business travel destinations stricken by civil unrest or natural disaster (a theme with a certain resonance in New Orleans, where memories of Hurricane Katrina and its aftermath are still powerful), Charlie pointed out the importance of having a plan ‘that was written when heads were cooler and there was time to think’. Organisations that do not have such a plan in place may face unnecessary and costly delays, confusion, and loss of confidence from evacuee clients. However, Charlie pointed out, a plan that is out of date can be as bad as or even worse than no plan at all. This was a presentation that looked at the specific needs of expatriates in destinations that may become trouble zones, and Charlie emphasised the importance of keeping location contact information updated and scheduling

a regular update for ‘traveller tracking’ list updates. Updating that plan should include regular updating of copies of the insured’s current travel documents, a tiered system of alerts to make everyone aware of existing threat levels, a primary contact between security and the rest of the company, and a clear list of who may be evacuated and who will not. Assistance companies have learned from events during Egypt’s recent troubles that dual nationals can experience problems when trying to leave the country after using ‘home country’ passports to enter. Some of those who entered on a ‘home country’ passport had their departures delayed, others were turned away at the airport, and still others were at risk of being treated as illegal immigrants. Charlie also highlighted the special needs of families with children, who will need extra supervision in an already traumatic and chaotic environment. Expatriates and employers should also have a clear-eyed view of local employees, who may wish to leave with their expat employers. Charlie also flagged up one slightly off-beat issue: evacuating family pets is problematic at best, given quarantine regulations and transport requirements. Summing up, Charlie said, preparation is the key and reducing the surprises can reduce unnecessary delays.

Jeff Winton,

director of partner development, iJet

Addressing the topic of ‘Political risk, disasters and evacuation co-ordination, Jeff Winton looked at several differing examples

of situations ranging from civil unrest to outbreaks of potentially fatal disease. Some cases clearly required evacuation, but as Jeff went on to point out, clear-headed analysis of events as they unfold may reveal that evacuation is not the best solution.First examining the impact of last year’s ‘Arab Spring’ and the chaos that engulfed Egypt beginning in January 2011, Jeff outlined how on-the-spot liaisons facilitated the evacuation of staff and researchers from various locations in and around Cairo, organising secure transportation, security escorts, movement to safe havens and ultimately evacuation to Spain by chartered aircraft.Key lessons from this experience, Jeff said, included the need for all parties to have full access to all available intelligence. Insurance providers in such situations, he said, need to ‘lean forward’ in case of rapid changes to the overall security situation. A cross-functional crisis management team is essential, comprising sales and account managers and underwriters on the insurance side, as well as medical evacuation and travel assistance suppliers, security personnel and other third-party providers. Round-the-clock communications support is also vital, and the crisis management plan needs to include a back-up plan to cope with rapidly moving events. Jeff also pointed out that evacuation is not always the best solution to a potential crisis. Looking at how the 2005 outbreak of the lethal Marburg virus in Angola was handled, he cited the case of an organisation with 300 employees and family members in the country. Media coverage was intense, and management was under strong pressure to organise evacuation. However, intelligence assessed the threat as a localised outbreak, analysts on the spot answered employees’ questions and allayed their fears, and as a result they and their families remained in Angola. None became ill, and through adequate intelligence and a measured response, the organisation avoided an unnecessary and costly evacuation. Similarly, Jeff looked at the case of a New York-based insurance company that initially wished to evacuate 1,200 personnel from Tokyo following last year’s Fukushima reactor incident. Again, after numerous conference calls and discussions with senior management, the evacuation was called off, saving the company some $300,000 in transport costs alone – another example, Jeff said, of how instant evacuation is not always the most appropriate solution.

Political risk, disasters and evacuation co-ordination

Welcome Function sponsored by


34 ITIC REVIEW

Arthur Diskin

vice-president and global chief medical officer, Royal Caribbean Cruises, Ltd (RCCL)

With close media scrutiny of the cruise industry following several incidents early this year, the panel on cruises and

response to medical emergencies onboard was bound to attract plenty of attention from delegates. Arthur Diskin opened by outlining the massive scale of the issues that leading cruise lines face. The world’s second-largest cruise line, Royal Caribbean, carried 4,624,974 guests last year onboard a fl eet of 42 vessels ranging in capacity from 700 to 5,400 berths, visiting more than 350 ports worldwide and employing 50,000 crew members. Although cruising has traditionally been thought of as a market for older guests – with all that implies for onboard medical care – Arthur pointed out that the demographics now show that the average cruise passenger is now aged from their mid-40s to early 60s, with considerable variation within RCCL’s several brands. Onboard care provision clearly has to be adjusted in view of this age variation, so that, for example, an onboard formulary needs to be extensive as well as appropriate to guest needs. And onboard medical capabilities are typically such that guests at sea may well be closer to appropriate treatment and diagnosis than they would be at home – typically, vessels carry one or two doctors, three to fi ve nurses, and staff and equipment that meets or exceeds American College of Emergency Physician standards, featuring equipment such as monitor-defi brillators, ventilators, digital X-ray, laboratory and teledermatology facilities. Acute cardiovascular critical care is central, with ACLS and critical care training reviewed on each ship annually to ensure high standards of care. After outlining the levels of care and equipment available onboard ships, Arthur went on to look at the process of deciding when and if a patient may need to be evacuated from the vessel. The medical decision always remains with the ship’s doctor, he said, but contact between medical staff , the ship’s captain, and RCCL’s Miami headquarters has to be close, with a dedicated care team who determines insurance status and facilitates the insurance process, engages emergency assistance and provides liaison with the patient’s family.

Wendy Slater

head of medical services, National Air Ambulance Florida

Wendy’s opener was a real attention grabber. As a fl ight nurse, she said, you know that all is not as it seems when the

fi rst thing you hear upon arrival is: “Man, am I happy to see you.” As head of medical services at Florida-based National Air Ambulance, one of the world’s longest established medical evacuation providers, Wendy has considerable experience at what might be called the sharp end of the medevac sector. She focused on the real need for clear and accurate diagnosis – particularly important in terms of the cruise line industry, where deciding whether or not to disembark a guest who presents more or less severe symptoms can be crucial. That could be of particular relevance to cruise line passengers, who typically present with an

array of symptoms associated with an older demographic. Just under 38 per cent of cases presented with cardiac or neurological issues, compared with only 8.5 per cent of trauma cases – fi gures that would seem to refl ect the relative safety and security of a cruise ship vis-à-vis a destination associated with adventure tourism, but also the relative medical vulnerability of some cruise passengers. She looked at the sample case of a 90-year-old cruise traveller who became ill on board some four days after falling from his motorised scooter. Though the patient had been cleared by onboard medical staff for re-embarkation, his partner noticed a deterioration in his mental and physical state over the following days, necessitating medevac intervention. In this case, she said, a successful outcome was achieved by a combination of appropriate initial treatment, triage and rapid transportation. Wendy’s presentation drove home the message that these three factors can be most important in responding to medical emergencies onboard.

Dr Robert Wheeler

medical director, On Call International

Dr Robert Wheeler looked at the essential requirements of a comprehensive emergency air ambulance checklist. The devil, he

revealed, is in the detail.Air evacuation, whether from a holiday resort, on-shore ambulance or from a cruise vessel, is a complex process, he pointed out, and in order for patients to be cared for and processed eff ectively, air ambulance companies, travel insurance providers and onboard medical staff must liaise promptly and eff ectively.The typical checklist is extensive, and Robert’s presentation highlighted the need for cruise lines to ensure the necessary information is readily available – ideally, by asking passengers to complete a detailed questionnaire when making their reservations, or failing that as soon as they are onboard the vessel. Apart from the obvious essentials – such as the patient’s name, nationality, gender, date of birth, and details of travel insurance and primary healthcare insurance – such a questionnaire should also help to amass a range of other information to expedite treatment, payment and claims processing. Approval from the travel insurance client must be confi rmed if transport is required beyond the closest appropriate hospital. Robert also looked at the tricky issue of guarantee of payment to the medevac provider from the patient or the cruise line if the patient is uninsured or if confi rmation of coverage is not immediately at hand. Credit card details should also be available to cover transport costs in excess of evacuation coverage. Other essential information must include mundane yet vital details including the patient’s social security number, travel documentation for the patient and any travelling companion, home address, telephone number and email address, and contact details for the patient’s home primary care physician and hospital.Meanwhile, the medevac operator’s checklist should include details of the cruise line, vessel, current ship location and estimated time of arrival at the port of disembarkation or rendezvous with tender or helicopter.All of this, as Robert pointed out, may seem obvious – but in a medical evacuation this mass of detail will save time, money and lives.

Cruises – the responseto medical emergencies onboard Fa� we� DinnerFa� we� DinnerFa� we� DinnerFa� we� DinnerFa� we� Dinner

LATROBE’S ON ROYAL, 403 ROYAL STREET

www.itij.co.uk

ITIC REVIEW 35

Tina Kelly

director of interactive marketing, McMurry

Tina Kelly was the fi rst speaker on Wednesday’s panel on the latest developments and opportunities in the Internet and social media. Tina’s

presentation kicked off hard, bringing us up to speed on a cold, hard fact: almost 90 per cent of users don’t get past the fi rst page of their search.Search engine optimisation (SEO), Tina said, is the key to using this new technology. This can include some cool stuff – including free tools such as Google Analytics and Google Webmaster, keyword research, link analysis and competitor such as SpyFu and Compete.SEO, Tina said, is the process of improving the visibility of a website or web page in search engines via natural or free-to-user search results. Building authority off -site is central to assessing the competition and leveraging other online assets, including microsites, social profi ling and Google profi ling. Tina went on to highlight how potential clients search the Internet for travel insurance, pointing to 8,100 searches per month globally (990 from the US alone) for Google business searches for travel insurance. Meanwhile, monthly searches globally reach 27,000 – 10,000 in the US alone.Tina’s presentation focused on the killer question: “OK – I need SEO. Now what?” SEO, she said, can target diff erent kinds of search strategies – ranging from image search, local search, video search, news search and industry-specifi c vertical search engines. Tina went on to show how SEO can be vital, with the slogan: “This is prime real estate!” Only one in 10 of search engine users got past page one of the results. Out of these, the top three results get the highest click through rate.

Tom Ruddy

president, The Ruddy Group

Tom Ruddy, of The Ruddy Group, is another forceful advocate of new social media as a vital marketing tool for the travel insurance sector.

Video has become the most potent driving force in terms of building supplier-client relationships, Tom said, pointing out too that the basics of diff erentiating your product from the competition are still key. In his presentation, Tom drove home the point that video technology – including online and smartphone content and web services such as Facebook, Twitter and good old-fashioned person-to-person email – has proved its ability to capture the buyer’s attention. Online visitors who view product and service videos are much more likely to purchase those products and services than those who do not, he said. Retail buyers who view video linger on-site two minutes longer than the average and are 64 per cent more likely to end up buying the product. Tom pointed to a recent Cisco survey of US and British consumers, which found that shoppers increasingly prefer to research products online, but still like to make in-store purchases. What this means, Tom argued, is that online video drives conversion and traffi c, but video tools bring ‘offl ine and online’ together. In short, people still like ‘face time’, he implied, even if the ‘face’ is virtual. Perhaps Tom’s killer fact, however, was this: by 2014, there will be more mobile Internet users

than conventional desktop/laptop users. Around half of local searches are already done on mobiles. More than nine out of 10 smartphone users use their devices at home, so the technology is already replacing old-style ‘fi xed’ devices. Tom cited research that indicates 90 per cent of smartphone searches are in

eff ect calls to action, and that mobile commerce is expected to reach US$119 billion within the next three years. Quoting YouTube’s vice-president of global content Robert Kyncl, he predicted that video will soon be 90 per cent of Internet traffi c. He also indicated that there is a high degree of trust among consumers when it comes to social media and digital technology disciplines. How can travel insurance providers tap into this? Tom went back to basics. Establishing and branding a company spokesperson, creating a clear competitive advantage proposition, and providing prospective clients with a clearly understandable menu of services, value-added information and customer testimonials. To sum up, Tom said, social media will encompass up to 20 per cent of a company’s total marketing budget within the next fi ve years – but a well thought out strategic marketing plan, solid branding and understanding of the company’s competitive advantages are still essential.

Alan Rambam

digital creative technologist, TPG

“Stop asking your customers to ‘like’ you,” was the perhaps surprising message from Alan Rambam, whose presentation focused on the hot topic

of selling the product via the latest, real-time traveller’s path to purchase – primarily, the latest generation of social media, mobile phone and tablet technology.Alan’s presentation pointed out that mobile technology may already be superseding online. Purchase intent via mobile, he said, is fi ve times that of online, while mobile is the bridge between ‘digital’ and ‘real’ life.Mobile technology now provides direct access to consumers right when they are making their

purchasing decisions – and that enables brands to infl uence their buying behaviour in new and powerful ways.Alan’s presentation highlighted the message that mobile is immediate, that social marketing is about giving your consumers a real reason to buy your products while they are in the real world. Alan highlighted two airlines – KLM and Malaysia Airlines – that have begun to off er ‘social seating’ programmes online, allowing travellers to choose their seat-neighbours on their next fl ight. He went on to look at travel trends such as ‘garden glamping’ in the UK – where homeowners in the umbrella of the 2012 Olympics are looking at renting out their lawns as camping spaces. Alan argued, powerfully, that ‘social fi ltering’ will drive the next generation of consumer content and discovery, making digital word of mouth a tool that the travel insurance sector cannot ignore.

Digital marketing:the Internet and social mediaFa� we� DinnerFa� we� DinnerFa� we� DinnerFa� we� DinnerFa� we� Dinner

LATROBE’S ON ROYAL, 403 ROYAL STREET


36 ITIC REVIEW

31 October - 1 November 2012Arts Hotel, Barcelona

For more details please visit

http://barcelona.itic.co

BarcelonaInternational Travel Insurance Conference

DATE & LOCATION

CONTACT

Sant

Seb

asti

a

Barc

elon

eta

Boga

tell

Nov

a Ic

aria

Mar

Bel

la

Nov

a M

ar B

ella

Liev

ant

Barr

y’s F

orum

Joe Sawyer

vice-president of marketing, American Well Systems

Telemedicine – using advanced information and communications technology to help onboard medical teams to diagnose and treat patients

with the help of hospital teams on shore – is becoming a hot topic for both cruise lines and travel and medical insurers.From the cruise line’s point of view, the ability to provide onboard, state-of-the-art diagnosis, medical advice and treatment even when many miles out at sea – for example, in the mid-Atlantic – offers an added sense of comfort and security for guests, especially older travellers or those with pre-existing medical conditions. It also very effectively assists onboard medical staff and travel insurance and medical evacuation providers in the crucial decision of whether or not a patient needs to be disembarked or can effectively be treated onboard.Opening Wednesday’s panel on remote monitoring, biometrics and telemedicine, Joe Sawyer described telemedicine as a ‘powerful tool’ for removing the walls to care delivery. This exciting new application, he said, is changing the way in which patients are treated when away from their usual health practitioner. By connecting patients online through American Well’s open network of partners – which, since the company was launched just over four years ago, has grown to include IT providers, pharmaceutical and hospital groups, US state governments and patient advocates – the company provides rapid access to practitioners and consultants. From the medical practitioner’s point of view, it can provide immediate access to the subscribing patient’s full clinical profile. It can also provide live, face-to-face consultation between patient and doctor via fast-moving technologies such as smartphones, laptops or tablet computers. Most importantly of all, from the insurer’s point of view, Joe’s claim that ‘online care has come to travel’ opens up new potential for electronic record-keeping, care continuity and customer satisfaction, with 90 per cent of patients using the system saving time, 85 per cent avoiding more expensive care settings and reporting their issues completely resolved, and 95 per cent customer satisfaction – the epitome of a win-win outcome.

Sharon Henry

director, American Medical Response (AMR)

Taking another look at the potential of remote monitoring and its ability was Sharon Henry, director at American Medical Response, the

US’s largest ambulance company, which also embraces EmCare, the leading provider of outsourced emergency department and medical services, and AASI, offering worldwide medical transport with its own fleet of six long-range Learjet aircraft. Drawing on her own long experience in the sector, Sharon pointed out that telemedicine has been around for a while, with doctors and paramedics using ‘biophones’ for communication at least 30 years ago.

What is new is how we might use the technology more effectively to help on-the-spot practitioners and paramedics to make prompt medical decisions. From the patient’s and insurer’s points of view, this could mean eliminating costly and time-consuming visits to emergency wards, clinics or general practitioners. Through new technology, the cost of care can be substantially reduced. Venturing into the realms of cyber-tech, Sharon said AMR was already piloting the use of remote robotics to ‘beam in’ specialist physicians to operate in smaller hospitals in remote locations. Similarly, she said, it is increasingly possible to add physician telepresence onboard air ambulance aircraft. Meanwhile, a plethora of new devices may become standard, ranging from GPS wristwatches that can be used to upload or download medical data, to in-vehicle technology that can monitor issues such as blood sugar levels. But Sharon also argued convincingly that the private sector is not yet effectively being repaid for its role in developing these new technologies and applications. These exciting new models make practical financial sense, she concluded, but healthcare reimbursement, at least in the US, has yet to catch up with the pace of development.

Scott C. Simmons

director of telehealth, University of Miami Miller School of Medicine

Wednesday’s final speaker, Scott C. Simmons, garnered appreciative chuckles from his audience when he declared

his presentation would be a ‘powerpoint-free zone’. Scott’s career began at NASA, working on remote medical solutions for US astronauts, so he is among telemedicine’s elite practitioners. Scott outlined two different but complementary modes in which telemedicine is used. Firstly, he said, ‘synchronous’ or ‘real-time’ use, employing live video or data telemetry to interface between patient and practitioner. This can be employed in virtually any kind of examination that can be video-transmitted. Secondly, he said, the ‘asynchronous’ model, in which data is transferred outside of immediate real-time, can be equally beneficial to both patient and provider, potentially offering substantial savings in time and cost. In terms of acuity, he said, a number of medical needs can be met outside of real time, especially in areas such as radiology and dermatology. Each of these different but complementary modes is highly dependent on how much remote connectivity and bandwidth is available, but given adequate connectivity, specialist care can be made available very rapidly, almost anywhere, even in areas where conventional resources are scarce or non-existent – Scott cited cases as different as treating astronauts in orbit, war casualties in Iraq, or earthquake victims in Haiti. But he also pointed to other, arguably less extreme areas where telemedicine will increasingly impact positively, such as reducing medical tourism costs. Telehealth, he said, offers medical tourism providers the possibility of remote pre-operation assessment, thus reducing the length of stay for patients and accompanying partners and therefore aiding cost containment for insurers.

Remote monitoring including biometrics and telemedicine

31 October - 1 November 2012Arts Hotel, Barcelona

For more details please visit

http://barcelona.itic.co

BarcelonaInternational Travel Insurance Conference

DATE & LOCATION

CONTACT

Sant

Seb

asti

a

Barc

elon

eta

Boga

tell

Nov

a Ic

aria

Mar

Bel

la

Nov

a M

ar B

ella

Liev

ant

Barr

y’s F

orum

With an increase of almost 10 per cent in international visitor numbers in 2011, Turkey

continues to be one of the world’s fastest growing destinations. Is its healthcare and medical assistance infrastructure keeping pace? Robin Gauldie reports

Turkey is one of the outstanding tourism success stories of the last two decades. Until the late 1980s, it could hardly be considered as a mass-market destination, though its cultural attractions and unspoiled coastline attracted reasonable numbers of independent travellers. In the late 1980s, low prices gave Turkey a competitive advantage over its biggest tourism rival, Greece, and over other European Mediterranean destinations. Major European tour operators and hotel groups took an interest in developing the country’s Aegean and Mediterranean coasts, new airports opened up fresh areas to international charter arrivals, and by the early 1990s the tourism boom was well and truly on. With minor interruptions, growth has hardly slowed since then. Tourist numbers passed the 10 million mark in 2001 and by the end of 2011 had reached 31.46 million, an increase of 9.86 per cent over the previous year. Tourism growth is only part of a broader success story. Successive governments have carried out a series of reforms that have modernised and diversified the nation’s economy and stabilised its currency. Tourism may contribute more than US$20 billion in foreign exchange earnings, but it represents only seven per cent of GDP, in sharp contrast to more tourism-reliant countries. Turkey has become a regional economic powerhouse, with Turkish companies involved in major infrastructure projects such as Tunisia’s new Enfidha international airport and Gaza’s new, US$35-million Teba Hospital. To an extent, this economic success has removed Turkey’s price advantage as a destination, with prices for many tourism-related commodities and services now on a

par with comparable European Union (EU) nations. Recent surveys have even suggested that Turkey is now more expensive for holidaymakers than Spain.

Everything to offerBut Turkey’s tourism success has been built on far more than bargain pricing. Diversification, in terms not only of source markets, but also of tourism products and destinations within Turkey, has been key to its remarkable success. In its early boom years, Turkey was heavily dependent on the major European tourism source countries, especially the UK and Germany. These markets have continued to be significant, but Turkey has also become a popular destination for Russian and Ukrainian holidaymakers

and to visitors from the Middle East. As a result, Turkey is much less vulnerable, in tourism terms, to currency fluctuations, economic problems in any single source market, or tour operator failures.In the 1980s and early 1990s, most accommodation offered by European package tour operators in

Turkey was in small, purpose-built hotels and apartment complexes, many of which were part-financed by large European tour companies in partnership with local tourism entrepreneurs, or in large, conventional three-star hotels. Since then, a plethora of new properties have opened.


38 ASSISTANCE&HEALTHCAREWORLDMARKETS

TALKING TURKEY

Successive governments have carried out a series

of reforms that have modernised

and diversified the nation’s economy and stabilised its

currency

Eastern Bosphorus Strait

The accommodation mix includes ultra-luxury palace hotels in resorts and in Istanbul, boutique townhouses, small hostels, purpose-built apartments and all-inclusive complexes.While May to October continues to be peak season for the mainstream coast resorts, Istanbul has

become a year-round destination. Many large resort and city hotels have also successfully developed the meetings, incentive travel, conference and exhibitions (MICE) market to fill rooms in winter and in the spring and autumn shoulder seasons. Turkey’s climate can be extreme, with temperatures rising as high as 40°C in midsummer and plunging well below zero in winter, with heavy snow on the high country of Anatolia and even in Istanbul.Turkey offers a tremendous variety of landscapes, from the rocky coasts and mountainous hinterland of the Lycian coast to the miles-long golden strands of the Mediterranean coast, east of Antalya, as well as a vast hinterland of plateaus and impressive mountain ranges. The human landscape is equally diverse, ranging from pretty harbour villages such as Kas and Kalkan to cities such as Marmaris, Bodrum and Kusadasi, where purpose-built resort areas surround historic centres. Istanbul, Turkey’s largest city, is now well established as a citybreak destination, its ancient Byzantine and Ottoman heritage enhanced by great food, outstanding shopping, superb museums and some of the finest hotels in Europe. Luxury thalassotherapy and spa holidays are also popular (Turkey is, after all, the birthplace of the hammam or steam bath) and most luxury properties in resort areas and in Istanbul feature health and beauty facilities operated by world-class spa brands. Throughout Turkey, ancient history is a powerful draw for cultural tourism, with the relics of some of the world’s most ancient civilisations and great religions dominating city centres or standing on deserted mountainsides. Cruise tourism is another growth area, and the port of Kusadasi has become a major port of call for cruise passengers visiting ancient Ephesus and its Temple of Diana, one of the seven wonders of the ancient world. Religious tourism also draws pilgrim groups, mainly from the US, to historic Christian sites including Ephesus, Demre, and Istanbul.Activity holidays are also significant, with a plethora of more or less risky activities on offer, from diving,

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 39

Eastern Bosphorus Strait

Bodrum



sailing, windsurfing, jet-skiing and other powered watersports to winter sports, white-water rafting, hang-gliding, microlight flying and hot air ballooning.

The challenging 509-kilometre Lycian Way is popular with determined hikers, demanding a high level of fitness, while the ascent of 5,137 metre

Mt Ararat in Turkey’s far east attracts even more adventurous travellers. Clearly, all of these generate demand for claims and assistance ranging from simple minor injuries to life-threatening accidents and deaths. In 2009 a British tourist was killed and nine others were injured when their hot air balloon, operated by Cappadocia Balloons, plummeted from a height of 50 metres after a mid-air collision with another balloon. Goreme in Cappadocia, famous for its spectacular rock pinnacles with their early Christian cave-churches, has become a popular centre for hot-air ballooning, with up to 45 flights every day in season.No surprise, then, that a certain cynicism greeted an announcement that Turkish company VIP Tourism has begun taking bookings for balloon flights into the stratosphere, starting in 2014. The flights, using a state-of-the-art craft trademarked ‘Bloon’ by its Spanish developer, will take four hours, reach an altitude of 36,000 metres, and will cost n110,000. Chief executive Ceylan Pirinccioglu said the company had located sites in Konya and Eskisehir provinces as potential ground bases. The rapids of the Dalaman River, close to some of the coast’s most popular resorts, have also been the scene of fatal accidents involving tourists. Richard Manning, a 66-year-old Briton, died after his boat flipped over in October 2009. Nine-year-old Cerys Potter died in July 2010 when the inflatable raft she was on capsized. Raft capsizes are said to be common on the nine-mile stretch of rapids (rated as ‘grade 4’ in difficulty on the commonly used whitewater sports industry scale of 1-6), and there have been suggestions that safety standards are lax.

Dramatic growthWith a land area of 780,580 square kilometres (more than twice the size of Germany and half as big again as France), Turkey has a population of almost 79 million, around 70 per cent of whom are city dwellers. Many of the country’s largest urban areas (notably Istanbul, with a population of more than 10 million) have grown dramatically in the last 20 years, mainly as a result of an accelerating ‘drift to the cities’ by rural work-seekers.Travel to the far east and southeast of the country, where Turkey borders Syria, Iraq and Iran and where Kurdish separatists have been active for decades, can be interrupted by clashes between Kurdish armed groups and the security forces, and military checkpoints are common on roads in this part of the country.The UK Foreign Office warns of ‘a high threat from terrorism’ and advises against all but essential travel to the provinces Hakkari, Sirnak and Siirt, on the Iraqi border, and Tunceli province, in eastern Anatolia. Turkey’s border with Syria is heavily militarised, and should violence by government forces against the Syrian opposition escalate any further, or even

the vast majority of visitors are concentrated in a relatively small area,

along the coast from Izmir in the north to the Antalya area in the south, and in Istanbul

Fethiye Oludeniz

The Blue Mosque, Istanbul

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 41

develop into full-blown civil war, there are obvious security implications for Turkey.Non-political gun crime is also an issue. Some 40 million people are estimated to have access to firearms in their homes. Nationwide, Turks own up to eight million firearms, only 2.5 million of which are registered. Around 3,000 people a year die in shooting incidents each year. Around 700 die accidentally, as a result of the national habit of firing celebratory volleys at events such as weddings and after football matches.Nor is Turkey immune from natural disasters. Up to 600 people died in earthquakes in the Van area of eastern Turkey in October and November 2011. The earthquake that struck the densely populated northwest in 1999 took a much heavier toll, leaving some 18,000 dead. Challenge extended The country’s geography presents some challenges for medical assistance companies. The distance between Turkey’s European border with Greece and its eastern border is around 1,700 km. Terrain is extremely varied, with rugged mountain ranges within sight of popular coastal resorts, swathes of semi-desert in the remote south-east, and peaks high enough to remain snow-capped all year round in the far south east. However, Turkey’s transport and communications infrastructure is generally good. In addition, the vast majority of visitors are concentrated in a relatively small area, along the coast from Izmir in the north to the Antalya area in the south, and in Istanbul. Most of the road network, at least in cities and in the most popular tourism areas, is generally as good

as those anywhere in Europe, with a network of four-lane highways connecting major cities. However, reckless driving and poorly maintained commercial and agricultural vehicles contribute to more than one million road accidents and some 4,000 fatalities yearly. The development of international airports at Izmir and Dalaman on the Aegean coast, and Antalya on the Mediterranean, has turned these areas into the main hubs for sun and sand tourism, and massive expansion of air capacity into Istanbul by low-cost

airlines has made the city much more accessible and affordable for short-break visitors from all over Europe and elsewhere. Ankara, Turkey’s capital, is less popular with leisure visitors but is a major business and meetings destination and is well served by Turkey’s national airline Turk Havayollari (Turkish Airlines) and other major international carriers.In all, Turkey has 16 international airports, including two in Istanbul. These are complemented by more than 30 domestic airports that connect regional capitals with Ankara and Istanbul. Independent airlines including Atlasjet, Pegasus, Onur Air and Sun Express complement and compete with Turkish Airlines’ internal flights and also operate some flights to Europe and the Middle East.Aeromedical operations are facilitated by the wide availability of civilian airports. In addition, Turkish military search and rescue aircraft can deploy from numerous military airfields and helipads. The Turkish Air Force operates around 20 Cougar search and rescue helicopters, built in Turkey in a joint venture between Eurocopter and Tusas Aerospace Industries, and its pilots are experienced in operations in extreme terrain and remote areas. State-operated civilian air ambulance services are

Most private clinics and doctors require immediate payment by cash or

credit card

The Blue Mosque, Istanbul

Cappadocia



operated by Sky Line Transportation, a division of the Kocoglu Aviation group, under contract to the Ministry of Health, using a fleet of 19 helicopters and two fixed-wing aircraft, operating from bases in 15 cities around Turkey. In November 2011, the Ministry of Health added two Hawker 900XP aircraft [with] Spectrum Aeromed interiors to its fleet of three Hawker900XP and one King Air 350 air ambulances.At sea, search and rescue (SAR) missions are carried

out by the Turkish Coast Guard, which is due to take delivery this year of four new purpose-built SAR vessels from Turkish shipbuilder RMK Marine. With cruise ships, tourist gulet schooners, private yachts and international ferries plying the coast, as well as clandestine vessels carrying illegal migrants seeking to enter the EU by crossing from Turkey to Greece, maritime SAR missions can also be complicated by jurisdictional issues between the two countries, because in many places only a few kilometres separate mainland Turkey from the islands of eastern Greece. Private air ambulance operators include Redstar Aviation. Launched in 2002, the company is headquartered at Istanbul’s Sabiha Gokcen International Airport, with regional bases in Izmir and Trabzon on the Black Sea coast. The company operates a BAE Jetstream 32EP and a Eurocopter BO105 helicopter, both equipped for intensive care, received ISO 9001 certification in 2003 and is Joint Aviation Authority compliant.Providing a bridge between hospitals in Turkey and

abroad, aeromedical rescue services, and insurance companies, Stars Crescent Assistance (SCA) offers multi-lingual medical staff and claims to be capable of providing insurers with almost continuous updates on the patient’s clinical condition.SCA recognises that there can be communication problems between international insurance medical staff and attending physicians in Turkey, and specialises in easing such communication issues.

Cash for careIn Turkey’s major cities and resort areas, many doctors and hospital staff speak some English and German, as do pharmacists, who can also provide first aid and basic health advice and diagnosis. Pharmacies also sell a range of remedies, such as antibiotics, which are available only on prescription in the EU and some other European countries (and almost all have prominent window displays advertising over-the-counter Viagra).Turkey is not a member of the EU, and European Health Insurance Cards (EHIC) do not entitle visitors to free healthcare. Most private clinics and doctors require immediate payment by cash or credit card (Visa being the most widely expected); however, most large private hospitals have agreements in place with major travel and health insurers. The Turkish state still dominates the healthcare sector, with a constitutional mandate to provide health, hospital and pharmaceutical services through a network of public hospitals and clinics that receive

most of their financing from the government, with around 13 per cent derived from fees paid by insurers or individual patients. There are plans to rationalise the complicated state healthcare system, which has historically been dominated by three separate social insurance funds.According to Dr Hans Biekmann, who took over as chief executive of Turkish assistance company MARM Assistance in December 2011, there are still significant differences in standards between public and private hospitals, attributable to underfunding, understaffing, and overcrowding. Thanks to the country’s remarkable economic performance over the last two decades, more Turks can now choose private healthcare and private medical insurance. As a result, Turkey has a plethora of large and sophisticated private hospitals.“Every single hospital in Turkey, be it public or private, possesses an emergency unit and trauma centre,” says Biekmann. “Finding an emergency unit, even in the most remote areas, would not be difficult.” Nevertheless, he says, the quality of emergency units at university hospitals and Joint Commission International (JCI) accredited private hospitals is significantly higher than those of small private and state hospitals. The private healthcare sector in the country continues to expand, with more than 40 JCI-accredited hospitals boasting the latest technology and foreign-trained doctors and medical staff. “We can confidently say that standards now meet and even exceed the quality of those found in Western Europe.” But, he says, there are significant issues around over-treatment, over-charging and unnecessary bureaucracy, so cost containment experts are almost essential partners for international insurers. By closely monitoring the treatment provided by hospitals, MARM says it can save insurance companies an average of 20 per cent on hospital costs. “We have even had cases

where the insurance company saved 70 per cent of their patient’s bill,” Biekmann claims. Turkish private hospital groups have also attracted international investors, and some Turkish private healthcare providers are exporting their expertise to Eastern Europe, the Middle East and Asia. According to Pinar Lembet, vice-general manager of finance at the major private hospital chain Acibadem, the private healthcare sector in Turkey is divided into ‘Group A’ hospitals that cater mainly for patients who have opted for full private medical insurance: “Essentially, the 1.5 per cent of the population with healthcare insurance, plus cash payers.” Group B hospitals cater for the much larger middle class, who use public insurance to partly pay for the service, and then pay an extra 30 per cent for private care. Acibadem, recently acquired by the healthcare division of Malaysian investor Khazanah Nasional, is now the second-largest hospital group in the world, with 11 general hospitals as well as a network of outpatient clinics and diagnostic laboratories. The Medical Park hospital chain, with 17 facilities across Turkey, was acquired by the US Carlyle Group in 2009, and now plans to export its expertise to nearby destinations, including Romania. Universal Hospitals Group, with 18 hospitals in 12 of Turkey’s large cities, has attracted a US$140-million investment from investors led by ADM Capital, to fund further expansion of its healthcare empire. Kent Hospital Group, based in Izmir, has recently been acquired by investment group Mid Europa. Driven by strong demand from Turks themselves, strong government involvement and a surprisingly healthy national economy as well as seemingly unstoppable growth in tourism, Turkey’s medical and assistance infrastructure appears well capable of meeting the needs of visitors and their insurers, and indeed seems set to export its expertise across neighbouring regions. n

In Turkey’s major cities and resort areas, many doctors and hospital staff speak

some English and German

Off-roading in Cappadocia

CATEGORY KEY CLAIMS MANAGEMENT INSURERS

AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE

AIR AMBULANCE INTERIOR

COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER

AIRCRAFT PERFORMANCE SOLUTION

CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING

ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE

CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS

COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES


44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

AMREF Flying DoctorsDr Bettina Vadera – Medical Director

Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 6000 090+254 20 344 170

email: website:

[email protected] www.amref.org

Assistance Médicale AfricaineDocteur Hage – Général Manager

Box 9962, Libreville, Gabon, GABON

tel: fax:

+ 241 07 88 80 80+ 241 44 10 20

email: website:

[email protected]

Netcare 911 InternationalJacques Pienaar – Fixed Wing Operations Manager

Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: fax:

+27 10 209 8392+27 10 209 8405

email: website:

[email protected]

West African Rescue AssociationFlorian Zagel – Managing Director

Klotey Cresent 6, North Labone, Accra, GHANA

24hr tel: tel:

+233 243 666 111+233 302 781 258

email: website:

[email protected]

AIRGURUS Ltd. Co. Capt. Harry Lero – President & CEODelta Air Hangar, General Aviation Area, Manila Domestic Airport, Pasay City, 1300, PHILIPPINES24/7 tel:

+632 781 0727+63917 596 6288

email: website:

[email protected]

AeroMed Asia Inc.Cindy Wong / Lorraine Paul – International Account Management

SINGAPORE BANGKOK THAILAND

tel: fax:

+603 7965 3883+603 7629 8810

email: website:

[email protected]

AirMed International LLCJeffrey T Tolbert – PresidentAirport World Trade Center, 1 Sky Plaza Road, Hong Kong International Airport, HONG KONG

tel: fax:

+852 3756 3680+852 3756 3681

email: website:

[email protected]

CareFlight Group Brendan Turgiev – Retrieval Services Manager

AUSTRALIA and NEW ZEALAND

24/7 (int) tel: fax:

+61 7 5553 5955+61 7 5553 5965

email: website:

[email protected]

CareFlight InternationalPaul Smith – National Manager

Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

tel: fax:

(+61) 2 9893 7683+61 2 9689 2744

email: website:

[email protected]

Flying Doctors AsiaPrithpal Singh – CEO , Director313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, SINGAPORE24hr tel:

fax: +65 9297 7757+65 6483 5407

email: website:

[email protected] www.flyingdoctorsasia.com

Hope Medflight Asia Pte LtdDr Charles Johnson – Medical Director

2 Loyang Lane 03-01, Singapore 508913, SINGAPORE

24hr tel: fax:

+65 6100 1911+65 6400 5254

email: website:

[email protected]

Medic’Air International 每递安国际Dr Huaqun Gao – Medical Director

885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

tel: fax:

+86 2163 558289+86 2163 558285

email: website:

[email protected]

Medical WingsDr Sura Jaidwatee, M.D. – Medical Flight Manager222 Room 3259, Bangkok International Airport, Viphavadee-Rangsit Rd, Sikan, Donmuang, Bangkok 10210, THAILAND

tel: fax:

+662 247 3392+662 535 4355

email: website:

[email protected]

ADAC-Ambulance ServiceRobert Glueck – Marketing & Sales Director

Hansastr. 19, D - 80686 Munich, GERMANY

tel: 24h Alarm:

+49 89 76 76 52 85+49 89 76 76 50 05

email: website:

[email protected]/ambulance

Air Medical LtdGlenn Salt – Director of Operations

Oxford Airport, Kidlington, Oxfordshire OX5 1RA, UK

tel: tel:

+44 1865 842 887+44 1865 370 642

email: website:

[email protected]

Alpine Air Ambulance AGPeter Meierhans – CEO

P.O. Box 233, CH-8058 Zürich Airport, SWITZERLAND

tel: 24/7 tel:

+41 44 813 09 09+41 44 813 10 10

email: website:

[email protected]

Augsburg Air AmbulanceRoland Schoberth – Director

Roseggerstr 17, D-86368, Gersthofen, GERMANY

tel: tel:

+49 821 299 1020+49 821 299 2030

email: website:

[email protected]

Capital Air CharterLisa Humphries – Sales Director

Hangar 68, Exeter International Airport, EX5 2BA, UK

tel: fax:

+44 845 055 2828+44 1392 350 039

email: website:

[email protected]

DRK AssistanceAndreas Speich – Managing Director

Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY

tel: fax:

+49 211 301805-0+49 211 301805-21

email: website:

[email protected]

European Air AmbulancePatrick Schomaker – Director Sales & Marketing

175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: fax:

+49 711 7007 7007+49 711 7007 7009

email: website:

[email protected]

FAI – rent-a-jet AGVolker Lemke – Director Sales & Marketing

Flughafenstrasse 100, D-90268 Nuremberg, GERMANY

tel: fax:

+49 911 36009 31+49 911 36009 59

email: website:

[email protected]

IFRA Assistance GmbH – AustriaMr. Christian Steindl M.D. – CEO

IFRA Assistance GmbH, Schießstattring 21, A-3100 St. Pölten, AUSTRIA

tel: fax:

+43 (0) 2742 49 11+43 (0) 27 42 89165

email: website:

[email protected]

Jet Executive International CharterIrena Dimitrijevic – Marketing & SalesMündelheimer Weg 50, D-40472, Düsseldorf, GERMANY“Homebase FRA & MUC”

tel: fax:

+49 211 602 7775+49 211 602 77766

email: website:

[email protected]

AIR

AM

BU

LAN

CE

(AFR

ICA

)

AIR

AM

BU

LAN

CE

( AU

ST

RA

LAS

IA)

(EU

RO

PE)

( AU

ST

RA

LAS

IA)

CATEGORY KEY CLAIMS MANAGEMENT INSURERSAIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINEAIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDERAIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENINGASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCECATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTSCOST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES

www.itij.co.uk

45SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected]

JET ICUMike Honeycutt – President

2561 Rescue Way, Brooksville, FL 34604, USA

tel: fax:

+1 352 796 2540+1 352 796 2549

email: website:

[email protected]

Latitude Air AmbulanceJeff McIntosh CANADAUSA

tel: fax:

+1 289 426 1133+ 1 289 426 1134

email: website:

[email protected]

LIFESUPPORT Patient TransportGraham Williamson – CEO

#9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: fax:

+1 250 947 9641+1 877 288 2908

email: website:

graham.williamson@LifeSupportTransport.comwww.LifeSupportTransport.com

Skyservice Air AmbulanceDavid Ewing – VP International Business DevelopmentMontreal/PE Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA

tel: fax:

+1 514 497 7000+1 514 636 0096

email: website:

[email protected]/airambulance

AIMSBernadette Breton – Managing Director

Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA

tel: fax:

+00 27 11 783 0135+00 27 11 783 2950

email: website:

[email protected]


Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 6000 090+254 20 344 170

email: website:

[email protected]

Assistance Médicale AfricaineDocteur Hage – Général Manager

Box 9962, Libreville, Gabon, GABON

tel: fax:

+ 241 07 88 80 80+ 241 44 10 20

email: website:

[email protected]

CONNEX Assistance Dr. Helmy El Tanahy – CEO

Office 11, Floor 1, 6 El Sad El Aali st, Dokki, Cairo, EYGPT

tel: fax:

+202 3 336 0005+202 3 762 0003

email: website:

[email protected]

Interhealth TechnologiesKevin Thomas – Director - International

P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

Medical Services Organisation (MSO)Vernon Pillay – Operations Director - International Division

PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA

tel: fax:

+27 (0)11 259 5403+27 (0)11 259 5001

24hr email: website:

[email protected]

Netcare 911 InternationalLouis Mabele – International Assistance Operations Manager

Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: fax:

+27 (0)10 209 8387+27 (0)10 209 8405


[email protected]

Malteser Service CenterJohannes Hoischen – International Network and Repatriation

Malteser Service Center Kalker Hauptstr. 22-2, 51103 Köln, GERMANY

tel: fax:

+49 221 98 22 333 +49 221 98 22 339

email: website:

[email protected]

Mayoral Executive JetJuan Carlos García Caparrós – Commercial Director

Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN

tel: fax:

+34 952 048 609+34 924 048 612

email: website:

[email protected]

Medic’Air InternationalDr Herve Raffin – General Manager

35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

tel: fax:

+33 141 72 1414+33 148 57 1010

email: website:

[email protected]

North Flying a/sJesper Kragelund – Sales Manager

North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

tel: fax:

+45 9632 2900+45 9632 2909

email: website:

[email protected]

Redstar AviationMustafa Atac – CEO

Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: fax:

+90 216 588 0216+90 216 588 0225

email: website:

[email protected]

Swiss Air-Rescue (Rega)Andreas Kirsch – Head of Mission Administration

Rega-Center, PO Box 1414, CH-8058 Zurich, SWITZERLAND

tel: fax:

+41 44 654 33 40+41 44 654 33 22

email: website:

[email protected]

Tyrol Air AmbulanceJakob Ringler – Managing Director

PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

tel: fax:

+43 512 224 220+43 512 288 888

email: website:

[email protected]

Aero Jet InternationalStuart Hayman – President

4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA

tel: fax:

+1 954 730 9300+1 954 485 6564

email: website:

[email protected]

Air Ambulance Professionals, Inc.Brian L. Weisz – PresidentFt. Lauderdale Executive Airport, 1535 South Perimeter Rd, Hangar 36B Ft. Lauderdale, Florida 33309, USA

tel: fax:

+1 954 491 0555+1 954 491 6114

email: website:

[email protected]

Air Ambulance SpecialistsTom Cox – Director of Business Development

345 Inverness Drive South, Suite A110, Englewood, Colorado, 80112, USA

tel: fax:

+1 720 875 9182+1 720 875 9183

email: website:

[email protected]

AirMed International LLCJeffrey T Tolbert – President

1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA

tel: fax:

+1 205 443 4840+1 205 443 4841

email: website:

[email protected]

Global Jetcare, Inc.Bart Gray – President

16479 Runway Drive, Brooksville, FL 34604, USA

tel: fax:

+1 352 799 7771+1 352 799 7776

email: website:

[email protected]

(NO

RT

H A

MER

ICA

)A

IR A

MB

ULA

NC

E( E

UR

OP

E)

ASS

ISTA

NC

E C

OM

PAN

IES

(AFR

ICA

)


AIR

AM

BU

LAN

CE

(N. A

MER

ICA

)



West African Rescue AssociationFlorian Zagel – Managing Director

Klotey Cresent 6, North Labone, Accra, GHANA

tel: fax:

+233 244 312 496/7+233 21 781 259

email: website:

[email protected]

GORAL ASSISTANCE CANADA INC. David Ohayon – Local Manager

2335 Stevens St, VSL, Montreal, QC H4M 1H1, CANADA

tel: fax:

+1 514 4481343+1 514 4481835

email: website:

[email protected] www.goralassist.com

SelectCare WorldwideMagdi Riad – President

2100 - 250 Yonge Street, Toronto, Ontario M5B 2L7, CANADA

tel: toll free:

+1 866 261 4441+1 416 340 7152

email: website:

[email protected]

World Travel ProtectionDavid McLean – Vice President, Sales & Marketing

400 University Avenue, 15th Floor, Toronto, ON, M5G 1S7, CANADA

tel: fax:

+1 416 205 4646+1 416 205 4676

email: website:

[email protected]

Assistance OnlineBertrand Guichoux – CEO

Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA

tel: fax:

+86 21 6104 9500+86 21 6104 9484

email: website:

bertrand-guichoux@assistance-online.com.cnwww.assistanceonline-china.com

Customer CareLouise Heywood – Marketing and Business Development Manager

Level 2, 15 Mount Street, North Sydney NSW 2060, AUSTRALIA

tel: fax:

+61 (0)2 9202 8222+61 (0)2 9202 8220

email: website:

[email protected]

EMS Assist Pilipinas Corporation (ASIA)Melanie Tabulina – CFO & General ManagerRoom 201, Second Floor, Delta Air Hangar, General Aviation Area, Manila Domestic Airport, Pasay City, 1301, PHILIPPINES24/7tel:

+632 478 9111+63917 421 8336

email: website:

[email protected]

East West RescueDr Kimberley Chawla – Program Director

37 Prithviraj Road, New Delhi 110011, INDIA

tel: fax:

+91 11 2469 0429+91 11 2469 0428

email: website:

[email protected]

First AssistanceMary-Jo McDonald – CEO

PO Box 17-310, Greenlane, Auckland, NEW ZEALAND

tel: fax:

+64 9 356 1650+64 9 525 1278

email: website:

[email protected]

Global Assistance & HealthcareMario Babin – Chief Executive OfficerCilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Jakarta 12560, INDONESIA

tel: fax:

+62 21 299 78 999+62 21 299 78 9555/66

email: website:

[email protected]

ADAC-Ambulance ServiceRobert Glueck – Marketing & Sales Director


tel: 24h Alarm:

+49 89 76 76 52 85+49 89 76 76 50 05

email: website:


Altas AssistanceSaulius Stepsys – Director/CEO

Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA

tel: fax:

+370 5 264 4020+370 5 264 4021

email: website:

[email protected]

(EU

RO

PE)

AP CompaniesNatalya Butakova – Business Development Manager

17 Varshavskoye Shosse, Moscow 117105, RUSSIA

tel: fax:

+7 495 989 1120+7 495 989 1130

email: website:

[email protected]

ARC Europe SAAlexander Zerzaihi – Network Manager

Avenue des Olympiades 2, 1140 Brussels, BELGIUM

tel: fax:

+32 2 706 6661+32 2 706 6601

email: website:

[email protected]

CNASCarole Luisy – Managing Director

80 rue des alliés, 38100, Grenoble, FRANCE

tel: fax:

+33 438 49 83 49+33 438 49 83 40

email: website:

[email protected]

DRK AssistanceAndreas Speich – Managing Director

Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY

tel: fax:

+49 211 301805-0+49 211 301805-21

email: website:

[email protected]

Global Assistance a.s.Petr Bold – General Manager

Dopraváku 749/3,184 00 Prague 8, CZECH REPUBLIC

tel: fax:

+420 266 799 770+420 266 799 797

email: website:

[email protected]

Global Voyager Assistance - RussiaCostas Danilenko – CEO

PO Box II, 125124 Moscow, RUSSIA

tel: fax:

+7 495 775 0999+7 495 775 0998

email: website:

[email protected]

Global Voyager Assistance - Black SeaOlga Turubarova – General Manager

77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE

tel: fax:

+38 048 7373 441+38 048 7373 442

email: website:

[email protected]

IFRA Assistance S.r.l. – RomaniaMs. Mariana Nadban – DirectorS.C. IFRA Assistance S.r.l, Calugareni Street 2, RO-310181 Arad, ROMANIA

tel: fax:

+40 257 21 82 91+40 257 20 10 20

email: website:

[email protected]

MD Medicus Assistance GmbHSven Scharff – International Network Manager

Industriestr. 2a, 67063 Ludwigshafen, GERMANY

tel: fax:

+49 - 621 / 5490 171+49 - 621 / 5490 029

email: website:

[email protected]

Malteser Service CenterJohannes Hoischen – International Network and RepatriationMalteser Hilfsdienst gemeinnützige GmbH Malteser Service Center Kalker Hauptstr. 22-2, 51103 Köln, GERMANYtel: fax:

+49 221 98 22 333 +49 221 98 22 339

email: website:

[email protected]

Marm AssistanceHans Biekmann – CEOGrup Center Is Merkezi, Mustafa Akyol Sok No. 158, Yenisehir Mah, Kurtkoy 34912, TURKEY

tel: fax:

+90 216 560 07 24+90 216 560 07 07

email: website:

[email protected]

med con team GmbHMichael Weinlich – Managing Director

Gerhard-Kindler-Str.6, 72770 Reutlingen, GERMANY

tel: fax:

+49 7121 433 660+49 7121 433 619

email: website:

[email protected]

ASS

ISTA

NC

E C

OM

PAN

IES

(AFR

ICA

)

ASS

ISTA

NC

E C

OM

PAN

IES

(EU

RO

PE)

(AU

STR

ALA

SIA

)(N

. AM

ERIC

A)

www.itij.co.uk


AP CompaniesNatalya Butakova – Business Development Manager

17 Varshavskoye Shosse, Moscow 117105, RUSSIA

tel: fax:

+7 495 989 1120+7 495 989 1130

email: website:

[email protected]

ChargeCare InternationalChristiane Burniston – Managing Director

Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: fax:

+44 1865 400 007+44 845 003 9923

email: website:

admin@chargecareinternational.co.ukwww.chargecareinternational.co.uk

Marm AssistanceHans Biekmann – CEOGrup Center Is Merkezi, Mustafa Akyol Sok No. 158, Yenisehir Mah, Kurtkoy 34912, TURKEY

tel: fax:

+90 216 560 07 24+90 216 560 07 07

email: website:

[email protected]

ProAmica LtdJoe Miller – General ManagerProAmica Ltd, General & Medical House, Napier Place, Peterborough, Cambridgeshire, PE2 6XN UK

tel: fax:

+44 (0)1733 362 880+44 (0)1733 362 881

email: website:

[email protected]

Active Care ManagementDavid Rivelis – Senior Vice President

3600 Rhodes, Windsor, ON, N8W 5A4, CANADA

tel: fax:

+(519) 945 8256 #4226+(519) 251 5165

email: website:

[email protected]

ONE AssistLinda Norman – Client Relationship ManagerPalma C/Cardenal Rossell No.1, Esc. A 2˚. Desp 8-9, Palma de Mallorca 07007, SPAIN

tel: 24 tel:

+44 (0) 1992 708 700+44 (0) 1992 444 337

email: website:

[email protected]

Save Assistance FranceFranck Molinier – Director of Business Development6 Rue Jean-Pierre Timbaud, Le Campus, Bat. B1, 78180 Montigny-Le-Bretonneux., FRANCE

tel: 24 tel:

+33 13062 6752+33 13062 1122

email: website:

[email protected]

SavitarLydia Semchenkova – Business Development Manager

25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: fax:

+7 495 987 1775+7 495 987 1776

email: website:

[email protected]

SOS InternationalHelle Drager Sandahl – Communications & Marketing Manager

Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: fax:

+45 7010 5055+45 7010 5056

email: website:

[email protected]

TBS Team 24 d.o.oEdvard Hojnik – General Manger

CROATIA, SLOVENIA, SERBIA, MNE, BH, KOS, MAC

tel: fax:

+386 2616 5819 +386 2618 5800

email: website:

[email protected]. tbs-team24.com

CONNEX Assistance Middle East Lara Helmi – International Network Director

Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: fax:

+97 14 257 82 84+97 14 257 82 85

email: website:

[email protected]

GORAL ASSISTANCE LTD Marcel Kadoche – International Network and Development Manager

Maskit 27 str. Herzeliya Industrial Park 46733, ISRAEL

tel: fax:

+972 9 9579930+972 9 9579931

email: website:

[email protected] www.goralassist.com

Dr Colin Plotkin & Sons Consulting INC.Dr Colin Plotkin – Managing Director

27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: fax:

+1 604 241 9677+1 604 241 0733

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice-President Sales73 Queen St, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Gdn, FL 34787 USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

AIMSBernadette Breton – Managing Director

Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: fax:

+00 27 11 783 0135+00 27 11 783 2950

email: website:

[email protected]



tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

Medical Services Organisation (MSO)Vernon Pillay – Operations Director - International Division

PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA

tel: fax:

+27 (0)11 259 5403+27 (0)11 259 5001


[email protected]

CA

TAST

RO

PH

IC

CLA

IMS

SPEC

IALI

STS

CO

ST C

ON

TAIN

MEN

T(A

FRIC

A)

CO

ST C

ON

TAIN

MEN

T(E

UR

OP

E)(N

AM

ERIC

A)

ASS

ISTA

NC

E C

OM

PAN

IES

(EU

RO

PE)

(MID

. EA

ST)





tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

ONE ClaimsLinda Norman – Client Relationship Manager

1-4 Limes Court, Conduit Lane, Hoddesdon, Hertfordshire EN11 8EP, UK

tel: fax:

+44 (0) 1992 708 700+44 (0) 1992 450 717

email: website:

[email protected]



tel: toll free:

+1 866 261 4441+1 416 340 7152

email: website:

[email protected]

Star HealthcareGigi Galen – President

850 7th Avenue, Suite 803, New York, 10019, USA

tel: fax:

+ 1 212 581 8228+ 1 212 581 8272

email: website:

[email protected]

Voyageur Aeromedical TravelMarc Lucas – General Manager

Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]

To have your company listed in our service directory

contact the sales department now:

[email protected] or telephone: +44 (0)117 922 66 00

ADACChristoph Ullrich – Director of Purchase / International Network


tel: 24hr Alm:

+49 89 7676 2912+49 89 7676 5005

email: website:


Lufthansa Medical ServicesDoris Ehring – Manager Sales & MarketingLufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, Frankfurt/Main, GERMANY

tel: fax:

+49 (0)69690-20904+49 (0)69690-58147

email: website:

[email protected]

Albin International Repatriation LimitedEmerson De Luca – Managing Director

George Alfred Dyer House, 51 Neptune Street, London SE16 7JP UK

tel: fax:

+44 20 7313 6920+44 20 7313 6999

email: website:

[email protected]

Flying Home Pte LtdMr Ang Ziqian – Director

Blk 4 Lorong 8 Toa Payoh #01-1345A, SINGAPORE

tel: fax:

+65 6253 0001+65 6353 5801

email: website:

[email protected]

Funeral Home AURIGA Ltd.Helena Sulikova – Chief of International Department

B. Nemcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC

tel: fax:

+420 724 257 899+420 416 732 582

email: website:

[email protected]

Funeralcare InternationalLouisa Killen – Repatriation Specialist

221 Upper Richmond Road, Putney, London, SW15 6SQ, UK

tel: fax:

+44 20 8788 5303+44 20 8788 2525

email: website:

[email protected]

www.co-operativefuneralcare.co.uk

FUN

ERA

L D

IREC

TO

RS

Coalition America, Inc.Matthew Lungen – Director, National Sales

Two Concourse Parkway, Suite 300, Atlanta, GA 30328, USA

tel: fax:

+1 404 459 7201+1 404 459 4408

email: website:

[email protected]

Dr Colin Plotkin & Sons Consulting INC.Dr Colin Plotkin – Managing Director

27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: fax:

+1 604 241 9677+1 604 241 0733

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice-President Sales73 Queen St, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Gdn, FL 34787 USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

Global Medical ManagementRaija Itzchaki – COO

1300 Concord Terrace, Suite 300, Sunrise, Florida 33323, USA

tel: fax:

+1 954 370 6404+1 954 370 8613

email: website:

[email protected]

Olympus Managed HealthcareSteven Jacobson – CEO

777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA

tel: fax:

+1 305 530 8600+1 305 530 0766

email: website:

[email protected]

OneWorld AssistTaka Katsube – Director Assistance & Cost Managment

10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

tel: fax:

+1 604 303 2113+1 604 276 4593

email: website:

[email protected]



tel: toll free:

+1 866 261 4441+1 416 340 7152

email: website:

[email protected]

Star HealthcareGigi Galen – President

850 7th Avenue, Suite 803, New York, 10019, USA

tel: fax:

+ 1 212 581 8228+ 1 212 581 8272

email: website:

[email protected]

UnitedHealth InternationalPhilip Brun – Vice President of Sales & Service

3100 SW 145 Avenue, Miramar, FL 33027, USA

tel: fax:

+1 954 378 0694+1 954 378 0771

email: website:

[email protected]

Global Assistance & HealthcareMario Babin – Chief Executive OfficerCilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Jakarta 12560, INDONESIA

tel: fax:

+62 21 299 78 999+62 21 299 78 9555/66

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice President of Sales73 Queen St, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Gdn, FL 34787, USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

LAIM

S M

AN

AG

EMEN

T

CLA

IMS

MA

NA

GEM

ENT

CO

ST C

ON

TAIN

MEN

T(N

OR

TH

AM

ERIC

A)

CO

MM

ERC

IAL

REP

AT

SP

ECIA

LIST

SC

RIT

ICA

L C

AR

E PA

TIE

NT

T

RA

NSP

OR

T


www.itij.co.uk


CareFlight Group Brendan Turgiev – Retrieval Services Manager

AUSTRALIA and NEW ZEALAND

24/7 (int) tel: fax:

+61 7 5553 5955+61 7 5553 5965

email: website:

[email protected]

CareFlight InternationalPaul Smith – National ManagerWestmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

tel: fax:

+61 2 9893 7683+61 2 9689 2744

email: website:

[email protected]

Medic’Air International 每递安国际Dr Huaqun Gao – Medical Director

885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

tel: fax:

+86 2163 558289+86 2163 558285

email: website:

[email protected]

Medical WingsDr Sura Jaidwatee MD – Medical Flight Manager222 Room 3259, Bangkok International Airport, Viphavadee-Rangsit Rd, Sikan, Donmuang, Bangkok 10210, THAILAND

tel: fax:

+662 247 3392+662 535 4355

email: website:

[email protected]



tel: fax:

+254 20 6000 090+254 20 344 170

email: website:

[email protected]

LIFESUPPORT Patient TransportGraham Williamson – CEO

#9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA/USA

tel: fax:

+1 250 947 9641 +1 877 288 2908

email: website:

graham.williamson@LifeSupportTransport.comwww.LifeSupportTransport.com

Redstar AviationMustafa Atac – CEO

Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: fax:

+90 216 588 0216+90 216 588 0225

email: website:

[email protected]


Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]



tel: fax:

+254 20 6000 090+254 20 344 170

email: website:

[email protected]

StandbyMDAlex Sánchez – Managing Director

777 Brickell Avenue, Suite 1370, Miami, Florida 33131, USA

tel: fax:

+1 305 459 4882+1 305 421 5575

email: website:

[email protected]



tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]

V Creative DesignSteve Annette – New Media Director


tel: fax:

+44 (0)117 929 4636+44 (0)117 925 2040

email: website:

[email protected]


GestitursaDr. Antoni Salas – General Managerc/ Marina 16-18, 5ª planta, módulo D. Torre Mapfre. 08005 Barcelona, SPAIN

tel: fax:

+34 93 224 74 99+34 93 221 21 61

email: website:

[email protected]

John Allison Monkhouse Co., Ltd (Thailand)Pim Karnasuta – General Manager

89/7 MOO 19, Soi Yingcharoen, Bangplee, Samutprakarn 10540, THAILAND

tel: fax:

+66 2382 5345-7+66 2261 7939

email: website:

[email protected]

Memora InternationalVanda Castro – Manager

Joaquim Mollins, 5-7 7 Planta, 08028 Barcelona, SPAIN

tel: fax:

+34 914 849 400+351 214 706 491

email: website:

[email protected]

Mortuary Brussels Airport | Worldwide Funeral Repatriations part of DELA

Greta Plas – Repatriations Manager

Ringlaan 49, 1930 Zaventem, BELGIUM

tel: fax:

+32 2 720 80 00+32 2 720 88 22

email: website:

[email protected]

Rowland Brothers InternationalMelanie Walkling – Partner

299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK

tel: fax:

+44 20 8684 2324+44 20 8684 8000

email: website:

info@rowlandbrothersinternational.co.ukwww.rowlandbrothersinternational.co.uk

ServilusaVanda Castro – Manager International DepartmentAgencias Funerarias SA, International Dept. Rua do Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL

tel: fax:

+35 121 470 6300+35 121 470 6499

email: website:

[email protected]

Baptist Health South Florida International ServicesYohandra Fuentes – Assist V-P/Int. Insurance Dev. & Revenue Mangement

8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA

tel: fax:

+1 786 596 2373+1 786 596 5979

email: website:

[email protected]/international

Boca Raton Regional HospitalRandall Chamberlain – Director of Business Development & Int. Services

800 Meadows Road, Boca Raton, Florida, FL 33486, USA

tel: fax:

+ 1 561 955 4685+ 1 561 955 5040

email: website:

[email protected]

Jackson Memorial Hospital InternationalLuis Felipe Arango – Vice President of International BusinessJackson Medical Towers, East Tower, Suite 829,1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA24hr tel:

tel: + 1 305 355 1212+ 1 305 355 5544

email: website:

[email protected]

University of Miami Health SystemJose Quesada M.D., M.B.A. – Director Finance & Operations

1099 N.W. 14th Street, Miami, Florida 33136, USA

tel: fax:

+1 305 243 9100+1 305 243 9101

email: website:

[email protected]

Vejthani HospitalLauranee Sirikasem – Assistant Marketing Director

1 Ladprao Road 111, Klong-Chan Bangkapi, Bangkok 10240, THAILAND

tel: fax:

(+66)-2-734-0000(+66)-2-370-1596

email: website:

[email protected]

FUN

ERA

L D

IREC

TO

RS

HO

SPIT

ALS

(N

OR

TH

AM

ERIC

A)

MED

ICA

L ES

CO

RT

ON

CO

MM

ERC

IAL

AIR

LIN

ESW

EB &

MED

IA

AD

VER

TIS

ING

TR

AV

EL

AG

ENT

SM

EDIC

AL

PR

OV

IDER

(AU

STR

ALA

SIA

)

( A

SIA

)

(AM

ERIC

A)

(AFR

ICA

)(E

UR

OP

E)


50 REGULARS

Star signs show true claims statsOne hopes that the above headline will be taken with the proverbial pinch of salt! But moving on, new research from Mondial Assistance has revealed that, on average, Taureans make the most expensive travel insurance claims, but are only the third most likely star sign to make a claim. In contrast, Capricorns have the lowest claims costs, but are the most likely to claim on their travel insurance. According to Mondial’s research, Capricorn, Gemini and Taurus are the top three signs most likely to claim. When it comes to average claims costs, Taureans took the top spot, followed closely by Virgos. Scorpios have the lowest number of claims and the second lowest claims costs as well, making them the safest travellers. While Capricorns have the highest number of claims, they are at the bottom of the claims costs chart. Sagittarians are believed to be the luckiest star sign in the horoscope and don’t mind taking risks, but the research shows they are some of the safest travellers, with the third-lowest claims costs and the second least likely to make a claim.Ben Smart, corporate, travel and health director of Mondial Assistance UK, said: “Clearly, we can’t use horoscopes to determine whether travellers are more or less likely to experience an emergency on holiday, but this analysis highlights how much costs can vary. Travel professionals need to advise everyone to make sure they take out adequate travel insurance, whatever their star sign.”

Ask a silly questionSpring has sprung in the northern hemisphere, and with it comes great excitement at the prospect that summer may be around the corner. With summer, of course, come summer holidays and people travelling to strange lands. Undertaking such travels can be a confusing experience for some, prompting more than one very odd – and, if one were being harsh, one could say silly – question from tourists to local officials. A collection of such questions has been put together by a UK newspaper, and there are some classics! A highlight was the genius who asked: “Are there any lakes in the Lake District?” Another excellent question from a stranger to the UK was: “In what month is the May Day demonstration?” The next one should be

prefaced with the explanation that Brighton is a seaside town south of London in the UK: “What is the entry fee for Brighton?” A question from a clear non-historian, who thinks that the town planners in the UK need to do a bit more homework: “Why on earth did they build Windsor Castle on the flight path of Heathrow?” Another stellar example of tourists speaking before they think was: “Is Wales closed during the winter?” This is Wales as in the country. Seriously.A foreign tourist at the beautiful and historic Whitby Abbey in North Yorkshire asked the local guide: “Why did they build so many ruined castles and abbeys in England?” A question from a tourist that had spent perhaps a little too long in the movie land of LA, and was unused to the joyous British weather: “What time do you switch the mist off?” And one from someone who should have done a little more geography at school – or at least before they set off on their holiday amid the islands of Scotland: “Which bus do I get from the Orkney Islands to the Shetland Islands?” And one final favourite from a tourist who should definitely have spent a little bit longer in school: “Which direction is North in Australia?”

Mile-high mealsHelen Sharman, Britain’s first astronaut, has teamed with two experimental food scientists to dream up a menu for space tourists that takes into account the fact that at altitude, we

need stronger flavours as our taste buds don’t work as well, as well as the fact

that in order to combat the radiation exposure, food high in antioxidants is essential. Ms Sharman said of her

efforts: “Like the best works of science fiction, the menu includes wonderful flights

of fancy, but raises key challenges facing

chefs catering for leisure travellers leaving earth’s orbit. The team have thought about

everything, from the need to increase mineral

and vitamin intake to the fact that crumbs and zero gravity don’t go together.”The menu that the team has designed includes some of the strongest cheese ever made, and a space age instant noodle in a pot based on a full traditional roast dinner. In addition, a Supersonic Salad has been

invented that uses leaves from crops that can be grown

in space, and Martianmallows – sweets that are light enough to store onboard.

email:[email protected]

www.vcreativedesign.co.uk

[email protected]

Tel: +44 (0)117 929 46 36

V Creative Design,Voyageur Buildings,43 Colston Street,Bristol, BS1 5AX, UK

We provide concise creative solutions for the travel insurance industry.If you want to discuss your marketing needs or design requirements do get in touch with us at our Bristol office.

C

M

Y

CM

MY

CY

CMY

K

VCD-121-qtrstrip-p39.pdf 1 24/01/2011 16:08

Grapevine• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPE- V

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

VIN

E • G

RA

PE

VIN

E •

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

•GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE VINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPE-

www.itij.co.uk

51ONTHEMOVE

www.itij.co.uk

ACE appoints Parfitt

All change at Cunningham LindseyLoss adjuster and claims management company Cunningham Lindsey (CL) has recently announced several new appointments and role changes within its Central and Latin American operations.The first appointment is Andrew Wilson, who has been chosen as managing director of the firm’s Bahamas office. Andrew started his career in 1991, before joining CL in Nassau in 2010.In Mexico, Steve Clayton has been appointed as president of the company’s local branch. Clayton started his career in insurance over 38 years ago as a claims technician and has progressed to his new role of president. Also in Mexico, Chris Miller has joined the company as a loss adjuster. He started his career in 2008 in London and joined CL in 2011. Elsewhere, Paul Sandbach has joined CL’s office in Venezuela. He has been in the insurance business since 1987 and has handled a variety of claims in the past 25 years, mainly in the construction, commercial and property arenas.In other news, Harry Roberts, director of risk and compliance for CL, has relinquished his responsibility for risk and compliance on the board of the company, in favour of moving back into a more hands-on role within the firm’s major loss team as a business interruption specialist. He said: “As I approach retirement, I have been gradually reducing my working week, but with the intention of working further into the future. Taking this approach in 2010 allowed me the time to work on my personal ambition of editing a new edition of Riley on Business Interruption Insurance.” The Riley publication has been the leading authority and definitive work on business interruption within the insurance industry.

CEGA enhances medical expertiseEmergency medical assistance and claims management provider CEGA Group has recruited two new doctors to join its existing in-house medical team.Dr Jude McSharry brings extensive experience to the UK company in both emergency medicine and general practice, including experience of co-ordinating medical evacuations from the developing world. His role with CEGA will be both as an emergency flight doctor and as a co-ordinating office-based doctor.Dr Frances Dear, who joins CEGA in the same

position as both flight and office-based doctor, has a background in general practice, with a special interest and an MSc in tropical medicine. She also has experience of emergency aviation medicine through working with the Royal Flying Doctor Service in Australia.

Dr Tim Hammond, chief medical officer for CEGA, commented on the moves: “These two appointments are a testament to CEGA’s commitment to offer the very best in-house medical expertise to our clients and customers; be that in an advisory or emergency capacity. The new doctors form part of a medical team that is on hand 24 hours a day, seven days a week, to serve individuals in need – wherever they are in the world.”

InterGlobal picks medical adviser

International private medical insurance (IPMI) provider InterGlobal has appointed Samantha Bloom as a medical adviser within InterGlobal Assistance, the company’s integrated 24/7 claims/assistance division, to join Caroline Hinder. Samantha further strengthens the operations team responsible for providing medical assistance to members. An Australian national, Samantha joins Caroline Hinder as a registered nurse in the UK, bringing a wealth of experience from the assistance industry. Both are trained in aviation medicine and have performed patient transfers from across the globe on commercial airlines and air ambulance aircraft

for a number of years.Marie-Christine Exon-Gallé, head of InterGlobal Assistance, said: “Our responsibility is to ensure that our members receive the best possible medical treatment, wherever they are in the world, while maintaining effective control of claims costs. We work closely with hospitals, clinics, ambulance and medical transfer specialists. Samantha’s and Caroline’s experience as both fully registered nurses and aviation medicine specialists are a great asset to our team.”

Mondial chooses Ireland leaderMondial Assistance Ireland has announced the appointment of Roland Hesse as country manager. The company, a member of Allianz Global Assistance, is one of the country’s largest assistance companies for the automotive, insurance and travel industries. Having joined Mondial Assistance UK in 1982 as a motor assistance co-ordinator, Hesse has since held

numerous managerial roles within the company, becoming operations development manager in 1995. He has been acting general manager in Ireland since last summer, and has now been promoted to country manager.In his new role, Hesse will be responsible for the overall strategy of the Irish business, including developing targeted market share, maintaining current business relationships and exploring growth

opportunities. Commenting on his appointment, Hesse said: “I am delighted to be taking on the role of country manager for Ireland. In a difficult marketplace, Mondial Assistance has continued to thrive here and I look forward to overseeing, with my team, the sustained growth of this truly global company in the Irish market.”

On Call expands sales teamUS-based On Call International has announced that Tom Davidson has been hired as the company’s vice-president of sales and marketing. In his new role, Davidson will focus on expanding On Call’s sales operations and continue to maintain and increase the company’s level of customer satisfaction. He will also be responsible for building and strengthening more direct relationships with corporations, educational institutions and other client groups.Mike Kelly, president and chief executive of On Call International, said: “Tom brings a vast amount of experience in sales and marketing, along with an excellent track record of handling corporate travel crises to the On Call International team. I’m confident he is the right person to take our sales and marketing division to the next level, as we expand our teams and introduce innovative new products to better serve our customers.”Davidson brings over eight years of experience to the company, including time spent at International SOS Assistance, where he acted as manager of account management and oversaw client communication.

Rothwell & Towler welcomes staffUK-based insurance specialist Rothwell & Towler has welcomed two new members of staff to its headquarters, increasing the customer service team to 14 people. The company operates several specialist insurance brands, including World First Travel Insurance.The two new team members, Malcolm Whittle and Sophie Williams, have been appointed to help the customer services team, enabling it to operate for longer hours and manage increasing call volumes across a range of travel insurance products and services. There are plans to recruit more team

members during the coming six months, with a view to bringing the number of people in the customer service team to 18.Martin Rothwell, managing partner of the company, said: “We’ve secured some great new talent in Malcolm and Sophie, both with a very solid background in customer service. They join a bright and enthusiastic team, dedicated to providing the very best customer experience possible. They also really enjoy and have a lot of experience travelling, which really helps them to understand and meet our customers’ needs.”

ACE in London has announced that Craig Parfitt has been appointed to head up its analytics and management information team for the accident and health business in Europe, the Middle East and Africa. He will be based in London and report to Fraser Watson, director of marketing for accident and health in the region. Parfitt has a broad spectrum of experience within the business and marketing insight field from banking, media and retail sectors, from companies including Capgemini, Detica and Carlson Worldwide.

Commenting on the appointment, Watson said: “As a business that relies on a deep understanding of consumer behaviour, it is essential that we gather insight and evaluate our performance in as much depth as possible. Knowing what people do, how they do it, why they do it and when, gives us business advantage and ensures we meet customer needs. We’re delighted to have Craig onboard in what is a key role, and he will be instrumental in growing the business and maximising the opportunities as we move the accident and health business forward.”

Roland Hesse

Dr Jude McSharry

Dr Frances Dear

essential reading for travel insurance ......essential reading for travel insurance industry...

Documents