INTERNATIONAL medical insurance for those living or working abroad is a growing part of the private health industry. Plans from British and overseas insurers are proliferating, but as with all insurance products, rates and levels of cover vary enormously.

Norwich Union is launching its 'international express care' from the beginning of March. Its benefits include paying for consultations, drugs, emergency dental treatment and normal pregnancy and has a limit of pounds 250,000.

CIGNA Employee Benefits, the British arm of the US corporation, has recently launched a new 'international benefits plan' catering for the requirements of the expatriate market. It provides multi-lingual claims assessors, multi-currency claims payment, international emergency services and a worldwide claims-handling network. An annual benefit of up to pounds 1m per person is provided.

Peter Taylor, global benefits manager of CIGNA, said, 'The requirement for quality employee benefits is increasing. Working abroad presents different needs and problems for which employees pay not be covered by domestic healthcare schemes. Seemingly everyday medical treatment may be inadequate or non-existent, therefore a benefits plan, with comprehensive healthcare cover, is essential.'

Bupa has upgraded its international service to include person alised membership cards, direct settlement, and 24-hour service. The card avoids the need for paperwork and makes it easier for hospitals to arrange direct settlement, said the Bupa International sales and marketing manager, Penny Howard.

PPP has recently added a Basic Option category to its 'international health plan', which is not available in the US and Canada and which limits the annual claims to pounds 12,000, with a pounds 150 excess per member.

The choice of policy and level of cover needed are dictated to a large extent by the cost of medical treatment in the country of residence. Rates are highest for cover in the US and Canada and lowest for cover in Europe. There are also local variations. Outpatient care, for example, is very expensive in Switzerland, Hong Kong and again the US.

PPP charges according to three geographical areas of cover - worldwide, worldwide excluding the US and Canada, and Europe including the UK.

The exclusions on international policies are similar to those on UK policies and include pre-existing conditions, cosmetic surgery, HIV and Aids, alcohol and drug abuse and chronic illnesses. Normal pregnancy and childbirth are, however, often covered under the more expensive policies.

Direct settlement of claims is more of an issue with international policies because it means the subscriber will not be exposed to a currency risk between paying the bill and being reimbursed. It also means that when expenses are high, as they can be abroad, subscribers will not have to fork out of their own pocket.