What Employers Need to Know About Rebalancing Faculty and Expat Health Insurance Coverage
It’s very common for international schools and employers of globally mobile employees/expats to structure their group health insurance plans with two areas of cover:
- Worldwide (WW) cover for American employees (including access to medical care in the United States)
- Worldwide excluding the USA (WWE) cover for non-American employees (excludes treatment in the United States; except for emergencies)
This dual-structure approach has long been seen as a way to balance access and affordability. But with rising medical inflation, many employers are now asking a key question:
“What if we move everyone to Worldwide excluding the USA (WWE) — would we save money, and would it make sense?”
Why Employers Are Considering the Shift
Premiums for plans that include access to healthcare in the USA are typically 1.5 to 2 times higher than WWE plans — sometimes more. The U.S. healthcare system is the most expensive in the world, and even limited access to it significantly increases insurer exposure.
So it’s no surprise that many schools and companies are now considering:
- Moving all staff — including Americans — to WWE coverage only
- Or, if everyone is currently on WW, moving the entire group to WWE as a cost-saving measure
On paper, the math looks compelling. But insurers may not price this change the way you expect.
The Most Common Scenario: Two Pools Becomes One
Let’s say you currently have:
- 40% of your staff on Worldwide excluding the USA (WWE) cover (non-Americans)
- 60% of your staff on Worldwide (WW) cover (Americans)
And you want to shift all 100% to WWE.
It seems simple — just apply the lower WWE rate across the whole group, and enjoy the savings, right?
Not quite.
Why Insurers Don’t Just Give You the Lower Rate
Here’s where many employers are surprised: when they request to move everyone to WWE, the insurer comes back with a new, higher WWE rate — higher than the existing WWE rate for non-Americans, though still lower than the WW rate.
Why?
Because most group plans — especially those with 100+ members — are experience-rated. That means your renewal pricing is based on your group’s actual historical claims.
So the insurer’s logic may be:
“Even though we’re removing U.S. access, this group still contains members — particularly Americans — who we believe will continue to drive higher utilization and higher-cost claims elsewhere. Based on our data, total claims will only decrease modestly — so we can’t offer the full WWE rate previously given to a lower-risk group.”
In many cases, the premium savings might only be 10-15%, even when U.S. access is removed.
What the Insurer Is Really Saying
Let’s say you’ve historically seen 20–25% of your group’s total claims coming from treatment in the U.S. If you remove U.S. coverage entirely, you’d expect those claims to vanish.
But insurers often assume that only part of those claims will truly disappear — while the rest may:
- Shift to other high-cost international markets (Singapore, Hong Kong, or the EU)
- Reappear as delayed or substituted treatment elsewhere
- Continue to be driven by the same high-utilizing members
So the pricing model may assume that only 10–15% of total claims are eliminated — and the premium is adjusted accordingly.
What If Everyone Is Currently on WW?
There are also some employers that have historically given Worldwide cover including the U.S. to all staff, regardless of nationality. This was more common in years past, when plans were cheaper and compliance was less complex.
Now, facing cost pressures, they’re considering moving everyone to WWE — often expecting dramatic savings.
But again, insurers may not offer the “standard” WWE rate — because the risk profile of the group remains largely unchanged (same staff, same behavior patterns), even if the geography is limited.
This shift can still produce meaningful savings, but employers must be prepared for:
- New WWE rates that are higher than existing WWE premiums
- Insurer requests for stronger contractual language around U.S. exclusions
- Limited short-term savings unless behavior also changes
What You Can Do as an Employer
Here are the best ways to manage this transition thoughtfully:
Ask for Transparent Assumptions
Request data or actuarial logic from your insurer to understand:
- How much of your claims are U.S.-based
- What portion they believe will “reappear” elsewhere
- How your revised pricing was calculated
Commit to Strong U.S. Exclusion Terms
To strengthen your position, make sure your plan has:
- A clear area of cover definition
- No exceptions for out-of-network emergencies in the U.S.
- Defined claim denial procedures for out-of-area care
Benchmark with Similar Organizations
We regularly help international schools and globally mobile employers compare their current pricing and risk profile against similar organizations in the region or sector.
Even if you stay with your current insurer, this helps build a better negotiation position.
How One World Cover Can Help
At One World Cover, we’ve supported dozens of international schools and multinational employers through this exact scenario.
We’ll help you:
- Understand the real impact of removing U.S. coverage
- Push back on unfair assumptions built into revised WWE pricing
- Benchmark your current plan structure against similar institutions
- Redesign your benefits to balance cost control and faculty/staff satisfaction
Ready to review your current area of cover strategy or test a new pricing model? Get in touch — we’d love to take a look and see how much more value you can unlock.
Please get in touch: [email protected] or click here to contact us.
