Cigna Global Health Benefits: Healthcare across borders – Javier Cano

With the global mobility of employees growing, health protection today is about much more than making medical payments on time. Finance Director Europe speaks to Javier Cano, European managing director Cigna Global Health Benefits, about overseeing the impact of a relocation on an assignee from departure, to settling in, all the way through to readjusting to life back in their own country.

As businesses across the world become more flexible about staffing plans, more global and more reactive to changes in the market, the nature, length and demands of foreign assignments are also evolving for employees. Where once an expat might have relocated to a distant location for a few years with his or her family, the trend is now for short-term assignments and cross-border commuting.

As the diversity of assignments increases, the importance of flexibility for expat employees as they adjust to their new lives has never been greater. As well as healthcare provision, staff may need help arranging other financial affairs, and adjusting to different cultural and regulatory protocols in new countries.

Javier Cano is European managing director of Cigna Global Health Benefits, which has provided healthcare plans for more than 50 years and currently serves around a million customers worldwide. He explains how increasing mobility and the evolving nature of foreign assignments have dramatically changed the nature of services required.

"Employers are increasingly interested in plans that not only give employees access to high-quality healthcare, but also provide additional support to successfully navigate the emotional and physical journey of an international assignment," he says.

With this in mind, Cigna provides a range of well-being and assistance services and non-medical plans in addition to its medical cover options.

The demands of individual regions are also becoming more defined, with companies eager to achieve cost efficiencies by purchasing services and plans tailored to local requirements.

"As organisations increasingly seek to grow internationally, they are focusing more on talent management and global mobility," Cano says. "This, in turn, has resulted in more attention being placed on the design and delivery of global benefits, in particular ensuring that plans are compliant and in many cases adapted region by region, rather than a 'one-size-fits-all' approach. An example of this is the growth of the Middle East as a key international market over the last ten years.

"Driven by compliance and economics, many clients have chosen to follow more regional recruitment and benefits strategies as they have expanded. Therefore, the products Cigna has developed for these clients have been designed to meet these needs and adapted regionally, in terms of benefits and service delivery."

While the last decade has seen major changes with regard to the nature and length of assignments and the resulting requirements for healthcare and assistance, by contrast, the fundamental needs and wants of the employees themselves have remained largely consistent.

Shifting expectations

An independent 2013 study into expatriate trends, co-sponsored by Cigna and the National Foreign Trade Council (NFTC), found that the areas identified as being of 'greatest importance' to assignees remained highly comparable to an associated 2001 survey. These were, namely, the benefits package; quality of life; quality of healthcare; professional development/job impact; status of family life; financial impact; and impact on family.

Commenting on the findings of the study and the ongoing trends observed by Cigna, Cano says, "The relative importance of these factors is particularly influenced by the presence of family on assignment. For example, expatriates with families are significantly more likely to access healthcare and use healthcare benefits.

"In terms of shifts in expectations, the areas increasing most in importance are quality of life, impact on the family and professional development.

Employees are keen for their employers to provide support in these areas before, during and after assignments. They also expect their HR staff to be well informed about these benefits and services, helping expatriates to navigate them successfully."

The research found that, while employers were doing well in terms of meeting their employees' expectations around the aspects that matter most, they could still do a better job of communicating benefits and services to their globally mobile populations. In many cases, lack of awareness was an issue, with younger assignees particularly affected.

In addressing this need to provide employees with the right information, online information tools, such as Cigna's mobile app and Envoy portal, have an important role to play.

"In the event of a natural disaster or a medical epidemic, like an outbreak of Ebola, our disaster recovery support allows us to react quickly to ensure that assignees are well informed and safe," Cano says. "In often challenging situations, we work with international assistance providers to arrange evacuation, and, of course, we have a 24/7 helpline and online tools for timely updates."

The research also found that the importance of different services to expatriates varies between regions, with medical preparedness topping preoccupations for the Middle East and Sub-Saharan Africa, cross-cultural training a primary concern for Asia, and getting finance and tax right most important for assignees to North and South America.

With such concerns at the forefront of employees' minds, ensuring that they feel ready - and are ready - from the moment they leave home for their new location is essential.

"Cigna supports employees at every stage of their assignment," Cano says. "At the early stages, acclimatisation and integrating with new cultures - on business and personal levels - are the biggest concerns for assignees. Cigna's strong focus on medical well-being recognises that the priority at this stage is to ensure the assignee and any accompanying dependants are fully prepared, and any existing medical conditions are being managed appropriately."

Last, but not least

While no one would question the significance of coaching and supporting individuals as they become acclimatised to life in a new country and confront unforeseen challenges along the way, another fundamental element of the assignee's journey is very often overlooked.

"The area where employers seem least likely to meet expatriate employee expectations is at the end of the assignment. Overall, the existence of formal repatriation programmes is low, and employee awareness of these programmes is even lower. This is a key risk for employers in terms of retaining high-value talent, post-assignment."

In the Cigna-NFTC study, 59% of expatriates stated that they were unaware of whether or not their employer tracks what happens to expatriates that have returned to their originating countries.

The danger of insufficient support for returning assignees, aside from the potentially detrimental effects to their well-being, is that notable numbers choose to resign shortly after returning home, taking with them the experience, skills and knowledge they have built up abroad.

Ongoing support

"Our experience and research shows that repatriation is a process fraught with challenges for both the assignee and the employer," Cano says. "At this stage, an engaged and motivated employee is critical.

"For this reason, our support doesn't end here. Cigna offers employee assistance programmes (EAP) and online coaching for stress management and resilience training during post-assignment."

The price tag of such wide-reaching support services is not inconsiderable, but is clearly outweighed by the cost of losing valuable resources in the instance of an employee choosing to move on, into the arms of a competitor. And for Cigna, the concept of reliable services managed in a cost-efficient manner is central to its offering.

This is particularly important in the area of compliance, where the regulatory expectations on the part of the host country are growing every year and, with them, demands on time and resources.

"With local health provision requirements, compliance remains a significant and growing concern for organisations with globally mobile employees," Cano says. "The old assumption that local laws 'don't apply to expats' is no longer true. A provider must demonstrate a capacity to be forward-looking and keep the employer informed of relevant changes in legislation in the future.

"Multinationals are looking for cost-management solutions to the problem of ever-tightening budgets. Cigna's approach is to focus on the key areas of prevention, network management, case management and control. Prevention, through targeted intervention and effective health and wellness programmes, is ultimately the most sustainable way of reducing healthcare costs."

Cooperation is key

As demands continue to evolve and increase into the future, the willingness of expatriate management providers to cooperate and collaborate will be central to delivering an efficient, comprehensive offering.

Employers will expect their expatriate management providers to work together in a more holistic way," says Cano. "All benefits and support will need to be easy for assignees to access and use, and be relevant to both their country of origin and assignment, and employers will also look to assignees to play their part. Within this, we can also help to educate employees so that they make the best choices to lead healthier lifestyles."

Javier Cano, European managing director Cigna Global Health Benefits.