Health matters

With new relocation and international assignment destinations emerging and threats to health and security increasing, we look at how employers can meet their duty of care towards employees on the move.

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See more features in the Autumn 2016 issue of Relocate magazine and on our Global Health and Wellness page.


As the latest global mobility surveys show, international assignments and business travel are on the rise. Organisations of all types and sizes are now sending their key talent overseas, often to remote or otherwise challenging locations. While the world may be shrinking, health and security risks to globally mobile employees are growing. These can be from infectious disease, physical or mental illness, injury, natural disaster, war or terrorist incident.Employee benefits company Jelf International is seeing a steady flow of overseas assignments into high-risk areas. “Developing countries such as Ethiopia and Ivory Coast are seeing economic growth rates of almost 10 per cent, backed up by World Bank statistics,” says international account manager David Hilton.“Private investment inflows are booming in such countries, and subsequent opportunities in industries such as infrastructure, banking and construction are creating the need for overseas talent. This has somewhat been curbed by global shocks and epidemics such as Ebola, but, after a period of recovery, business is gradually starting to pick back up in affected areas.”Political barriers, Mr Hilton adds, are easing in certain areas, creating significant opportunities for international growth.“A widely published example is Iran,” he says, “which has seen a gradual relief of financial sanctions, starting in January 2016. Those exposed to the significant drop in crude oil prices over the last year are likely to see this as a route to diversifying and generating alternative revenues. Global businesses like Boeing have already obtained sizeable contracts in Iran, which will drive overseas assignments; however, many organisations will be cautious, as uncertainty remains.”
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David Hilton points out that escalating global risks, health epidemics, humanitarian issues and political threats are also increasing pressure on NGOs, which have increased their number of overseas assignments in response.Led by customer demand, there is a trend for international private medical insurance (iPMI) providers to integrate security with healthcare cover and other products. Allianz’s range of corporate assistance and risk management solutions, for example, includes integrated health, travel, security, occupational health and employee assistance programmes.Risk advisory and security services company Solace Global is partnering with CEGA, a provider of emergency medical and security assistance, to launch INtrinsic, a new programme that mitigates risk for insurers and organisations that operate or send employees abroad by providing a full range of security and medical services via a single contact point.Kieran Lavy, tactical intelligence analyst at Solace Global, says, “We are seeing a number of enquiries from technology firms and oil and gas firms for security provision in locations such as Libya, Chad, and Angola. Other corporations, academic institutions, and the media are looking for support to cover travel to increasingly high-risk locations, including Somalia and Pakistan.“We have also recently conducted evacuations from Iraq, Somalia and South Sudan.”

Managing risk

To fulfil their duty of care and increase the chances of a successful assignment, employers must reduce and manage risks to their assignees and themselves.“Risk assessment requires knowledge of the traveller, their itinerary, their destination, the potential health and security risks, and a documented approach to reducing these as far as possible,” says Randall Gordon-Duff, head of corporate travel at Collinson Group.A thorough understanding of the employee’s physical and mental health gives the company an understanding of the risks (to the individual and the organisation) of sending that employee overseas, and ensures that the employee is properly supported in the new location and productive in the job from day one.Potential risks to the organisation of not properly assessing and preparing employees for international travel include unforeseen costs, duty-of-care breaches resulting in damage to the employer brand, and failed assignments.Randall Gordon-Duff points out, “As international assignments often involve substantial investment from companies, and failed assignments can have financial implications for the bottom line, there is a financial interest for employers to ensure that their employees receive the support they need.“Businesses should ensure that proactive engagement and effective pre-deployment are at the heart of any international mobility or HR policy. It is key for HR professionals to understand who has responsibility for managing the complexities of sending staff abroad, as well as to provide pre-deployment support to evaluate an employee’s suitability for the assignment.”

iPMI: adapting to new realities

International private medical insurance is an essential building block of employers’ provision for their international assignees, though research from Jelf suggests that some employers still believe that the European Health Insurance Card and/or travel insurance provide sufficient protection for employees working or travelling overseas.Adam Harding, business development manager at Jelf says, “The simple message is that international PMI is a vital consideration for expats. Travel insurance may also be required by overseas staff, particularly if travelling outside their base location. Policy wording will include clear guidelines about how often employees can travel and how long they can be overseas.” Gone are the days when iPMI was just about providing care for expatriates who fell ill. Spurred by demand from employers keen to meet their duty of care and avoid unnecessary health-related costs, iPMI providers are expanding their offering to include wellness and screening services, employee assistance programmes (EAPs), and apps and other technologies designed to help employees to take control of their own wellbeing.Wellness at work is a relatively new concept, but one that is gaining traction as its value to businesses and individuals is increasingly recognised. Earlier this year, a CIPD report, Growing the Health and Wellbeing Agenda: From First Steps to Full Potential, highlighted the role of healthy workplaces in closing the UK’s productivity gap.The value of work–life balance, and with it the importance of good mental health, is also becoming accepted by employers. Globally mobile employees, who must adapt to a whole new environment as well as a new job, may be particularly vulnerable to the effects of stress and need help with managing it.

EAPs: next-generation support

By addressing wider issues than the purely physical, international employee assistance programmes are a logical next step in supporting globally mobile employees.
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Depending on the individual provider, EAPs can play a useful part in helping employees to acclimatise to new surroundings by offering support in a wide range of areas, from eldercare and childcare to legal, financial and relationship issues, workplace conflict and even home maintenance.As an indication of the growing recognition among employers of the importance of supporting employees’ overall wellbeing, Aetna International is now providing its EAP as a standard benefit across most of its international healthcare plans.Going one step further, the Health Insurance Group recently introduced a worldwide EAP combined with a range of “intercultural solutions” covering destination, selection and preparation, and repatriation, designed to help employers to promote successful international assignments.

Technology tools

In recent years, apps for mobile devices have joined health insurers’ websites in making it easy for expatriates and international assignees to access health information, support and other health-related services.Shortlisted in the Technological Innovation category of the Relocate Awards 2015/16, the Allianz MyHealth App, from Allianz Worldwide Care, allows employees on the move to submit health insurance claims quickly and easily, track their progress and access policy documents even where there is no internet access – vital for those working in remote locations. Users can also obtain advice on a range of topics and access useful online tools.Consulting firm Mercer is partnering with remote care company Babylon to provide access to GP and specialist consultations within minutes via video consultation, phone call or text message. A monitoring system keeps track of everything from key organ functions to cholesterol levels, checking billions of symptoms. The information is then analysed by Babylon’s doctors, who can suggest preventive measures if necessary.Jelf predicted at the start of 2016 that, with rising costs driving the need for innovation and technological advances, the use of wearable technology would also be crucial in meeting future global healthcare challenges.

A partnership with employees

Pre-departure, employers should ensure that their international assignees are fully informed about healthcare provision in their destination country, manage their expectations and put in place appropriate medical evacuation plans.Expatriates should be made aware that, even in relatively developed parts of the world, the standard of medical care may be very different from what they are used to. Language may also prove a problem.
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Employees must take an active part in promoting their own wellbeing. This includes, says Jelf’s David Hilton, familiarising themselves with the benefits and assistance packages provided by their employer, and ensuring they have all pertinent information to hand.They should also ensure they have a pre-departure check-up, keep relevant vaccinations and immunisations up to date, and, in regions where specific diseases are a risk (the Zika virus in Latin America being a topical example), follow advice on personal hygiene and avoid contact with potential sources of infection.Solace Global’s Kieran Lavy says, “Understanding the basic travel advice for each country can make the difference between a successful trip and a disastrous one. Simple steps can keep you much safer. These include knowing what areas of your destination are less safe, whether the water is safe to drink, whether you should be taking anti-malarial tablets and Deet spray, what taxis to use or avoid, is it safe to walk around at night, and so on.”

Security at the forefront

Recent terrorist attacks in France and Belgium, as well as civil unrest in Germany, have placed safety and security at the top of the agenda for organisations with globally mobile employees.Managing risks to employee safety is now as much a consideration for employers with assignees in Europe and other parts of the world formerly considered to pose low risks as it has previously been in parts of the world traditionally regarded as higher risk.The recent earthquake in Italy is a reminder that expatriates can be caught out by natural disasters even in areas generally regarded as low risk.As a sign of the times, APRIL International UK is offering all new clients free access to Red24’s travel and risk management services. Also partnering Red24 is Allianz Worldwide Care.
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Says Kieran Lavy, “Employers should use a provider who can supply pre-travel planning (including an intelligence briefing and location-specific training where appropriate), security for the journey (including travel-tracking technology and in-country security personnel for higher-risk travel), and provision for worst-case scenario situations, such as access to a crisis management team capable of providing immediate life-saving advice and medical and security assistance.“For journeys to low-risk locations, client-operated mobile-device-enabled travel-tracking technology helps an employer fulfil their duty of care. It also enables an employee to inform their employer of their whereabouts should a security situation occur in a location believed to be low risk.“In high-risk countries, and after major events, a country’s cellular network may not be working or may be limited, in which case a satellite device may be more suitable.”In the area of security, again, employees must work with their employer by familiarising themselves with local culture, infrastructure and risks before they go on assignment, and by taking sensible precautions.Kieran Lavy says, “We recommend that someone knows where you are and would know if you did not make it back to your hotel, for example. Consider organising a regular check-in time, be that hourly, daily, or weekly depending on the risk environment. Travel-tracking technology enables employees to check in at the click of a button rather than using a phone call or email.”

Looking ahead

What of the future? Jelf’s Doug Rice believes that, as international healthcare becomes less affordable, it becomes more of a cost and less of a benefit, leading employers to look at alternative ways of managing their budgets.“There will be an emergence of higher co-payment schemes, larger deductibles and excesses, and improved risk management to support a growing cost-conscious consumer and employer,” he says. “The ageing population puts a strain on healthcare and makes it more expensive, so there will be an increasing emphasis on collecting good data to improve prevention.”

For more news and features about health and wellness, visit our Global Health and Wellness section.

The following sections may also be of interest: International Assignments, Technology


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