Africa-only, worldwide excluding the USA, or worldwide: choosing an area of cover

IPMIAfrica explains the decision that moves the premium and the protection more than any other: whether your international private medical insurance covers Africa only, the world excluding the USA, or the whole world, and how to choose for the life you actually lead.

What area of cover means

Every international health insurance plan defines a geographic area within which treatment is covered. Inside the area, the plan pays for eligible treatment up to its limits. Outside it, most plans cover only emergency treatment for a limited number of days per trip, and some cover nothing at all. The area is chosen at quote stage and written into your certificate, and it is the single biggest influence on the premium after age.

The area of cover is about where you are treated, not where you live. Your country of residence is used for pricing and must be inside the area, but the area can be much wider than the country. The question to ask is not "where do I live?" but "where might I be treated?"

The three main options

Insurers use their own names and draw their own boundaries, but most offer three broad choices.

Some insurers offer a further split, for example a regional area with Europe added, or worldwide excluding a short list of territories rather than only the USA. These are worth asking about, because a regional area with the one extra region you need can cost less than worldwide excluding the USA.

How insurers draw their regions

There is no standard map. One insurer's "Africa" may include the whole continent and the Indian Ocean islands; another may place Egypt, Morocco and other North African countries in a Middle East and North Africa region, and Mauritius in an Indian Ocean or Asia-Pacific grouping. Some draw a Sub-Saharan Africa region that leaves out the north and South Africa, or treat South Africa as a separate higher-cost zone.

This matters in two directions. First, your country of residence must be inside the area you choose, and under the name the insurer uses. Second, the places you might be evacuated to must be inside it too. An expat in Tanzania whose regional area does not include Kenya has a problem, because Nairobi is where they would be sent. An expat in Morocco whose Africa area does not include Europe has a similar problem if they would want treatment in France or Spain.

Before you compare on price, ask each insurer to confirm in writing which area your country sits in and which countries are inside the area you are quoted. The IPMIAfrica insurer pages describe how each insurer structures its areas.

Area of cover and evacuation go together

Evacuation is covered on medical grounds and will take you to the nearest appropriate facility, wherever that is. But the treatment at the destination is only covered if the destination is inside your area of cover. An Africa-only plan may fly you to London if the assistance team decides that is the nearest appropriate facility, and then leave you to pay for the treatment, because London is outside the area.

So the honest way to choose an area of cover is to ask where you would realistically be treated for a serious condition. For many expats in Nigeria, Ghana or Kenya, the answer includes Europe, the UK, India or home, which points to worldwide excluding the USA. For some in South Africa, the answer is South Africa itself, and a regional area may be enough. Our evacuation guide explains how the benefit works.

The USA question

The United States is separated out because its healthcare is far more expensive than anywhere else in the world, and a plan that covers it has to price for that. Including the USA raises the premium substantially for everyone on the plan, whether or not they ever go there.

Most expats in Africa do not need it. Those who do usually have a clear reason: a home or family in the US, frequent business travel there, children at university there, or a specific condition for which they would want US treatment. If none of those apply, worldwide excluding the USA gives you the rest of the world at a far lower cost.

Check what the plan does if you visit the USA on an excluded-USA plan. Most cover emergency treatment for a limited period per trip, and some offer a short-term extension you can buy for a specific visit. That is usually a better answer than paying for full US cover all year.

The cost trade-off

In order of premium, Africa only is cheapest, worldwide excluding the USA is next, and worldwide is the most expensive, with the step to worldwide much larger than the step from regional to worldwide excluding the USA. Those are the only safe generalisations; the actual difference depends on the insurer, your age and your country of residence. Our cost guide explains the other drivers.

The trade-off is not only price against reach. A regional area with a lower premium may let you afford a higher tier, with outpatient cover and a lower excess, than you could on worldwide excluding the USA. Conversely, choosing a wider area and dropping to inpatient only may give you the reach you need at a similar cost. Decide the area first on the basis of where you would be treated, then fit the tier and excess to the budget.

• Choose Africa only if you are confident that you would be treated within Africa for anything serious, your country and the regional hubs are inside the insurer's definition, and you rarely travel outside the continent.
• Choose worldwide excluding the USA if you want the option of treatment in Europe, the UK, India or your home country, or you travel outside Africa for work.
• Choose worldwide only if you have a specific need for US cover.

Changing your area of cover later

Most insurers let you change the area of cover at renewal, and some mid-term if you move country. Widening the area usually requires no new underwriting but may be subject to conditions; narrowing it reduces the premium. If you expect to move, for example from Kenya to the Gulf or to Europe, ask before you buy whether the plan can follow you and what happens to the premium when it does.

If you travel outside your area, check the out-of-area emergency benefit: how many days per trip, what it covers and whether it includes evacuation back into the area. Nomi asks where you live and where you travel so that the plans it ranks have an area of cover that fits.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to an experienced broker.