International health insurance in Africa: the complete guide

IPMIAfrica's plain-English guide to international private medical insurance for expats and families across Africa: what it is, who needs it, what it covers, how it differs from local and travel cover, and how to choose a plan.

What international health insurance is

International private medical insurance (IPMI) is health cover that is not tied to one country's system. It pays for private treatment in the countries inside your chosen area of cover, usually for a year at a time, and most plans are renewable for life. The insurer is typically based outside Africa, the policy is written in English or French, and the premium and limits are set in US dollars, euros or pounds.

It was designed for people whose lives cross borders: expats on a posting, families who have settled abroad, retirees, remote workers and people who move between several countries over a career. In Africa it is also used by many citizens who want access to private care at home and abroad on predictable terms.

The alternatives are local health insurance, which is built around one country's hospitals and currency; travel insurance, which is built for emergencies on short trips; and paying out of pocket. Each has a place. None of them does what IPMI does, which is to give you consistent private cover wherever you live and travel within the area you chose.

Who needs it in Africa

International health insurance is not for everyone. If you are a citizen living in a city with good private hospitals, a local plan that covers them may be the right answer. The people for whom IPMI is usually the better choice are:

• Expats on a posting with corporate, diplomatic, development, mining, energy or education employers, especially where the employer's local plan does not cover treatment abroad or evacuation.
• Families who want private maternity, paediatric and routine care, and the option of treatment outside the country for anything serious.
• People living away from the main cities, on project sites, farms, conservancies or coasts, where the nearest hospital able to handle a serious case may be a flight away.
• Retirees in places such as Mauritius, Morocco or South Africa who need cover that renews for life and is not tied to a job.
• Anyone who travels within Africa for work and wants one plan that works across borders rather than a patchwork of local and travel policies.

Our country guides set out the position in each of the markets we cover, from South Africa to Kenya and Nigeria.

What it covers

Most plans are built in tiers. Inpatient is the core and is always included; the rest are modules you choose.

• Inpatient: hospital admission, surgery, intensive care, cancer treatment and the other large, expensive events. Day-patient treatment, where you are admitted and discharged the same day, is usually grouped here.
• Outpatient: GP and specialist consultations, diagnostics, physiotherapy and prescriptions, often with an annual cap.
• Maternity: antenatal care, delivery and postnatal care, almost always with a waiting period before you can claim.
• Dental and optical: routine and major dental, eye tests and glasses, usually on a higher tier.
• Evacuation and repatriation: transport to a hospital that can treat you when the local one cannot, and the journey home once you are stable. In Africa this is not an optional extra; see our evacuation guide.
• Mental health, wellness and chronic condition management: included on some tiers and not others.

Two numbers decide most of the protection and most of the price: the annual limit, which is the most the plan pays in a year, and the area of cover, which is where you are covered. Our inpatient vs outpatient guide explains how the modules fit together.

IPMI, local cover and travel insurance

These three are often confused. They solve different problems.

Many African countries also run a national health insurance scheme aimed at citizens and residents. Where one exists, you or your employer may be required to register and contribute. These schemes provide a defined package of care through public and contracted facilities. They are a floor, not a substitute for IPMI, and they do not pay for treatment abroad. Check the rule that applies to you with your employer, the authority or a qualified adviser.

Area of cover: Africa only, worldwide excluding the USA, or worldwide

Area of cover is the single biggest lever on both protection and premium. Most insurers offer three broad choices, and some offer regional variations within them.

• Africa only or a similar regional area covers you across the continent, sometimes with the option to add Europe or another region. It is the lowest-cost choice and suits people who will be treated locally or in a regional hub such as Nairobi or Johannesburg.
• Worldwide excluding the USA covers almost everywhere, including Europe, the UK, India and the Gulf, which are the common destinations for treatment abroad. Most expats in Africa choose this.
• Worldwide adds the United States. Because US healthcare is far more expensive than anywhere else, it raises the premium substantially. Only pay for it if you genuinely need US treatment.

Insurers draw their regions differently. One may place Egypt or Morocco in a Middle East or North Africa region; another may put Mauritius in an Indian Ocean grouping. Check that the plan treats your country of residence as inside the area and that it includes wherever you would realistically be evacuated to. Our regional vs worldwide guide goes into the trade-offs.

What drives the cost

There is no single price. The same person can be quoted very different premiums for broadly similar cover depending on the insurer and the choices made. The main drivers are:

• Age. Premiums rise with age, usually in bands.
• Area of cover. Including the USA is the largest single step up.
• Cover level. Inpatient-only is cheapest; adding outpatient, maternity and dental adds cost.
• Excess or deductible. Agreeing to pay the first part of a claim lowers the premium.
• Who is covered. Adding a partner and children.
• Medical history. Confirmed at underwriting, and may lead to exclusions or a loading.
• Country of residence. Insurers price by where you live, reflecting local treatment costs and claims experience.

Our cost guide explains each driver and how to use it to bring a better plan into reach.

Pre-existing conditions and underwriting

Every insurer deals with your medical history in one of a few ways. Under full medical underwriting you declare your history and the insurer tells you before you buy what is covered, excluded or loaded. Under a moratorium you do not declare up front; conditions you have had recently are excluded for a set period and may become covered if you stay symptom and treatment free. If you are switching from another international plan, the new insurer may offer to carry over your existing terms. Our pre-existing conditions guide explains each option and when it suits.

How to choose a plan

Work through these in order.

1. Where do you live and travel? This sets the area of cover and decides whether Africa only is enough.
2. Where would you want serious treatment? In many African countries the honest answer is a regional hub or your home country. The area of cover and evacuation benefit have to reach it.
3. Who needs covering? Just you, or a partner and children.
4. What must be included? Outpatient, maternity, dental, chronic care. Be honest about what you will use.
5. What excess could you absorb? A sensible excess can bring a better plan within budget.
6. Can the insurer bill your hospitals directly? In much of Africa, private hospitals ask for a deposit on admission unless they have an arrangement with the insurer.

Then compare the whole market for that brief, not just the one plan a single broker sells. The IPMIAfrica insurer pages explain how each of the main plans is built, and our comparisons such as Cigna vs Allianz put two side by side. Nomi does the same thing across 20+ insurers in one conversation.

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.