Investing in health

And no, I don’t mean buy shares in Glaxo.

This blog post is a tricky one to write, for reasons that will probably soon become clear. I want to pass on a piece of advice that relates to investing (in a broad sense) in your personal health. But first, a story.

A few years ago I was on a plane from New York to London – the final leg in a return journey from South America. A third of the way into that flight, somewhere over the Atlantic, with lights dimmed for the overnight journey, comes a voice over the tannoy;

“If there’s a doctor on board, could you please identify yourself to a member of the cabin crew.”

No doctor is on board (on a 747 – what are the odds!) but a couple of nurses on board volunteer to assist with the unfortunate traveller. The economy row becomes a mini doctor’s cubicle, a drip hanging from the overhead baggage compartment as the pilot consults with a panel of airline doctors back on the ground in the USA.

It soon becomes clear that the situation is fairly serious; we’re headed back to North America. Not to New York but St Johns, Newfoundland. Canada.

What feels like an eternity later, we land in St. Johns. Paramedics board the plane but their trolley can’t fit down the narrow aisles. A bloodied passenger, wrapped in an airline blanket, slowly traipses down the aisle, pausing halfway to catch a breath in the crew vestibule. At the front of the plane the paramedics scoop them up and rush them to hospital. The plane remains on the tarmac for a number of hours and then heads on to London (via another unplanned stopoff in Dublin).

After several weeks in Canada that involve a variety of medical interventions, a diagnosis of Stage 4 Lymphoma, a week in ICU and a first round of chemotherapy, our traveller is deemed stable enough to travel back to the UK to continue treatment. Five gruelling months or so later, our lead character is in complete remission (and, touch wood, remains so 3 years later).

That traveller was me.

Why do I tell you this story? Not for the fun of it but because it’s a perfect example of why my first piece of advice is so important.

Buy good travel insurance.

Don’t scrimp on this. In all likelihood you won’t need it, but if you do and don’t have it (or have bargain basement cover), the costs can blow away everything you’ve built in one fell swoop (or bankrupt you, in a worst case scenario).

To illustrate – my sojourn in Canada involved bills for (and this is a non-exhaustive list from those invoices I can remember):

  • Paramedics
  • Blood transfusions
  • Intensive Care Unit costs
  • Anaesthetist fees
  • Drug/chemotherapy
  • Repatriation

All in all, a conservative estimate would be that this amazing care from the Canadian Health Service set my insurer back approximately £250k.

You may be lucky enough to have £250k lying around for just this eventuality but I suspect that you still have other uses for that money. Think of travel insurance (and, in countries where public health provision is not available or isn’t good – health insurance) as protection for your most valuable asset – yourself. If you insure your belongings or your house but not your health, what does that say about your priorities?

Think of travel insurance and health insurance as protection for your most valuable asset – yourself.

So, what do you need consider when looking at travel insurance policies? A few thoughts are below (though I recommend you have a look at sources such as Which and MoneySavingExpert) as despite my in-depth experience of the system, I am far from an expert:

  1. What geographical cover do you need? A lot of providers offer an ex-North America category of cover, which (as the name suggests) will only cover you in countries other than the USA and Canada. If you’re not travelling to this part of the world this may be fine. BUT. Consider whether you have any connections in this part of the world, or whether it is conceivable that you could end up in North America if something goes wrong. My story above is a perfect example of this – the flight that was diverted was a connection through New York. My travelling companion only had ex-North America cover – if our places were switched, he would have been on the hook for around £250k.
  2. Workplace policies are generally better. This is a generalisation but generally corporate schemes involve better cover and when considered on an annual basis, more cost-effective. It’s clearly still important to read the scheme literature to check the exact details, but from experience this sort of cover is less likely to involve major exclusions for pre-existing conditions, or major price increases if they do. This is also my final piece of advice.
  3. If you have a pre-existing condition make sure you declare it if asked. The temptation not to declare may be high in some cases; especially where the premium is significantly higher due to this factor. If you fail to declare a relevant pre-existing condition not only are you extremely unlikely to be covered for complications related to this condition, but you will probably invalidate the entire policy.

Increased premiums for pre-existing medical conditions (PEMCs) can feel like an unfair tax on the least fortunate, and to be blunt, in many cases it is. This is an interesting area of debate; insurers will argue that higher risk profiles equal higher premiums, while individuals with pre-existing conditions will argue that not all pre-existing conditions are created equal. Both of these positions have some merit but this is a debate I don’t want to get into too far here. In some cases, pre-existing conditions can be considered ‘expired’ after a certain amount of time has elapsed.

If you are interested in understanding more, the FCA published some work in this area and there are a number of specialist insurers/brokers who may be able to provide more appropriate cover than the big firms. Which provides a good guide to travel insurance for cancer patients. Hopefully greater understanding of the diversity of PEMCs will lead to more specialist insurers entering this space.

One final thought with the uncertainty of Brexit lying just over the horizon. In Europe we’ve all become used to the idea that within the EU, as European citizens, we’re all covered by the European Health Insurance Card (EHIC). Post-Brexit it’s increasingly unlikely (especially in a “no-deal” scenario) that this will remain the case.

What I’ve been reading this week

Financial Nordic provides some thoughts on what he wishes he’d learned in High School and University and considers whether P2P lending is socially responsible.

A guest post on Monevator sparks an interesting moral debate about Expat Investing.

FIREvLondon writes about how to become a millionaire on £40k pa in London.

The FT (paywall) considers how to recession-proof your portfolio and the Woodford Saga continues.

GuardianApple launches the Apple Card, which by all accounts you can’t touch, breathe or move near.

Have a healthy weekend.

TTI

PS. I’m a supporter of Bloodwise, a specialist UK charity helping patients and research into all blood cancers. If you feel you can, any kind donations to their work will help in the fight against a number of different blood cancers. I was very lucky; many are not so.

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