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Increasing globalization may lead to more employer use of international assistance plans, which help overseas employees find medical care and with other concerns, benefit managers, consultants and assistance providers say.

"The idea behind it is that you want to make sure that all employees feel comfortable when they work in another country," said Cheri Alexander, vp-personnel for General Motors International Operations in Zurich, Switzerland.

But many companies do not fully understand how international assistance works, how it differs from insurance coverage and how to choose a provider, benefits consultants warn.

International assistance providers typically offer networks of 24-hour call-in centers with multilingual staff that provide medical advice and referrals to network providers; legal services; and personal assistance, such as help with lost luggage or stolen passports. They often guarantee payment for care in countries or hospitals that require such a guarantee to accept a patient. In cases of political turmoil, such as the situation recently in Indonesia, or medical emergencies that require help not available in the host city or country, IAPs organize evacuations to the closest city or country with appropriate medical care or sometimes even repatriations.

Most IAPs provide their services to employees and their dependents. Some also keep clients' medical records on file to help diagnose health problems more quickly and correctly. At least one IAP even provides members with information on etiquette for the host country, restaurant recommendations, and help in sending flowers should a member have forgotten a spouse's birthday.

A new trend among IAPs is medical prevention services, executives at several IAPs said. For example, some offer vaccination information and immunizations before trips abroad, and they may help clients assess the health services available in destination countries for certain medical conditions, such as asthma or diabetes.

A significant majority of international companies already provide assistance through an IAP as part of their benefits packages for travelers and expatriates, said Doug Morris, head of the expatriate administration practice in the United States at Hewitt Associates L.L.C. in Lincolnshire, Ill. But today "there is heightened awareness, because more companies transfer employees around the world," he said.

That includes small start-ups and exporters, said John Knapp, vp-marketing for Trevose, Pa.-based International SOS Assistance Inc., part of the International SOS Assistance group of companies in France. International SOS Assistance group will probably change its name soon because it was acquired by Singapore-based AEA International on July 1.

"More and more companies are expanding globally, and not only in Europe and Japan," he said. "There is more and more competition in developing countries."

These developing countries in Asia, Latin America, the former Soviet Union, Eastern Europe and Africa often have health care systems that do not meet Western standards, benefit consultants said.

Language barriers and employees' unfamiliarity with foreign health care systems make international assistance a benefit that can provide a level of comfort that lets employees focus on their work even in places with developed health systems, consultants said. "If you send an employee on an international assignment, one of the first questions will be 'Can I get health care?' " said Mr. Morris. "So, you must provide an avenue or a resource" for cases of emergency.

IAPs prevent employees from having to spend time on organizing help for themselves, thus allowing them more time for their work, said Jouco Bleeker, lead at the International Assistance Consulting Practice at William M. Mercer Inc.'s San Francisco office. "Employers want less hassle and want to provide a social service net," he said. "It makes sense for both, employers and employees."

"It saves us time and resources, because the IAP has already made the contacts" with appropriate medical providers, said James Lewis, benefits manager at Jackson, Miss.-based chemicals and plasma technology company Chem First Inc. "And at $10 per person per year, it is not a big item."

The company has approximately six expatriates and about 12 international travelers that go to countries such as Japan, China, Belgium, the United Kingdom and Italy, Mr. Lewis said. The IAP services "keep them focused on why they are there," he said.

Chem First offers the assistance benefit "mainly for travelers," Mr. Lewis said. "With expatriates, we work to locate providers at their (overseas) locations" based on U.S. or local health care plans as soon as they are settled.

GM's assistance benefit is open to a broader spectrum of employees. The company has overseas operations in more than 130 countries, and has about 2,500 expatriates, and all of them have access to assistance services, Ms. Alexander said. In addition, recently "we expanded the service to travelers," she said, "because globalization leads to increased travel."

"In a crisis, an employee wants quick help," she explained, giving the example of a recent emergency in Poland. An employee's wife needed quick medical treatment for an infection, but when the family wanted to bring her to a clinic that GM had identified as one of the best in the city, the clinic's admissions office was closed. The family called International SOS, which arranged the woman's quick transfer to another appropriate clinic.

While IAPs organize assistance in medical and other emergencies, don't confuse them with medical insurance companies, consultants and IAPs warn.

"A lot of employers mix up whether they have assistance or insurance," said Linda Kessler, vp at Aon Consulting's international practice in Chicago. "They often think they are covered. Yes, they are covered for the assistance, but they get the bill" if they are not covered for certain expenses, such as those for medical evacuations, through the assistance provider or an insurance company.

Also, IAPs don't pay medical bills. Assistance providers' work and purpose fundamentally differ from those of insurance companies, said Bruce Bigsby, vp at Global Emergency Medical Services Inc., an IAP based in Atlanta. "Insurance companies are really focused on reimbursing you for the care received," he said. "We want to make sure that you obtain care and get better."

"We are not competing with insurers," added Laura Hilton, director of provider relations at Timonium, Md.-based MEDEX Assistance Corp. "We are an additional benefit, an enhancement."

Indeed, instead of competing, insurance companies and assistance providers nowadays often cooperate, with insurers offering assistance as an integral part of their policies.

"Over the last few years, this (form of cooperation) has exploded," said Shelia Barnes, vp-sales and marketing at Washington, D.C.-based Worldwide Assistance Services Inc., another giant in the assistance industry. Worldwide Assistance, which currently serves only international travelers but soon will develop an assistance plan for expatriates, does offer its services directly to individuals and corporations, but "the insurance market is the largest (market) for us," Ms. Barnes said. Worldwide Assistance serves most clients through about 10 insurers that offer assistance services.

Cleveland-based American Greetings Corp., a wholesale and retail trader, uses an insurance plan that includes international assistance, according to David Walters, American Greetings' corporate manager-employee benefits planning. About 70 travelers and two or three expatriates have an accidental death and dismemberment policy with New York-based American International Group Inc. The assistance is provided by AIG's AIG Assist division in Houston, he said.

The issue of an IAP came up a couple of years ago, he said. "One of our senior officers became ill in an English-speaking country and raised the concern of what might have happened in a worse situation or in a non-English-speaking country," he said.

When American Greetings looked into available assistance services, Mr. Walters said he realized the service was already available to his firm through an existing insurance policy. "Since AIG is a huge company and has medical providers all over the world, we thought, why spend additional money?," he said.

American Greetings is not the only company that initially did not know the details of its assistance plan, consultants say.

Benefits managers are often surprised to learn that an IAP's contract excludes some things from covered costs, such as political turmoil, pre-existing conditions or maternity, Ms. Kessler said. Her advice to companies is to "understand what you are buying."

Also, when looking for the right IAP, companies must understand their own service needs, Mr. Bleeker said. "Most providers claim to be able to span the world, but many have" a focus on certain geographic areas and weaknesses in others, he said.

In general, benefits managers should be careful with IAPs and check out their claims of services more closely, Mr. Bleeker said. For example, "many IAPs will say they will provide a lawyer" for legal assistance, he said, "but ask them more closely. Some have one lawyer in an area but no alternative when he's on lunch break or vacation.'