All EU/EEA countries have universal public healthcare, but expats often rely on private plans for faster service and visa compliance. Private international plans (IPMI) provide modular coverage (inpatient, outpatient, dental, repatriation, etc.) across countries. Leading global insurers for expats include Cigna Global, Allianz Partners, AXA Global Healthcare, Bupa Global, William Russell, IMG/Globality Health, and April International. These insurers offer multiple tiers of plans with varying limits (often from $1M up to unlimited annual cover) and optional add-ons. For example, Cigna Global’s flagship plans are Silver ($1M limit), Gold ($2M) and Platinum (unlimited), each with core benefits; AXA and Bupa similarly offer 4–5 levels of cover. Insurers emphasize features like large global provider networks (Cigna: 1.5 million doctors), 24/7 telehealth support, mental health services, and fast claims reimbursement. Recent trends include digital-first services (now offered by units like Axa, Allianz, and new insurers such as Now Health) and the inclusion of wellness benefits. For high-end clients, specialized brokers (e.g. Riviera Expat) curate tailored plans with “white-glove” service.
Top International Health Insurers – 2026
| Provider | Plan Tiers | Coverage Highlights | Notable Features | Sources |
|---|---|---|---|---|
| Cigna Global | Silver, Gold, Platinum (+“Close Care”) | Worldwide, $1M–$∞ limits | Modular benefits; 1.5M-provider network; 24/7 support | 3 |
| Allianz Partners | Base, Enhanced, Signature (Care Plans, new Nov 2025) | Worldwide, simplified 3-tier (inpatient core) | Built-in private hospital room, repatriation; maternity coverage; outpatient add-ons | 9,10 |
| AXA Global | 5 Levels: Foundation to Prestige Plus | Worldwide | Global network (2M+ providers); mental health, second opinions, virtual doctor; direct billing | 6,1 |
| Bupa Global | 5 Plans: Major Medical, Select, Premier, Elite | Worldwide (regional option on lower tiers) | Lifetime renewals; large direct-billing network; wellness benefits (Elite covers evacuation) | 11 |
| William Russell | 5 Plans (WorldChoice, WorldOption, WorldElite) | Worldwide | Strong outpatient focus (consultations), mental health, telemedicine; high limits available | / |
| IMG/Globality | Focus World (3 tiers) (Asia: iPMI plans) | Worldwide, especially North America + Asia | Budget/mid-range friendly; optional Europe-only vs Worldwide; good for young expats | 12 |
| April International | 4 Levels (International to Exec Plus) | Worldwide | High-end concierge service; flexible coverage tailored to expats and HNW clients | 14 |
Notes
Above providers all offer evacuation and repatriation in core plans. Most plans allow excluding or restricting USA (to lower premiums). Outpatient cover (doctor visits, specialists, tests) and dental/vision are typically add-ons in global plans. Premiums depend on age, country, and level of coverage. Recent industry surveys (Cigna 2026 Global Mobility Study) highlight rising demand for flexible expat coverage worldwide.
Coverage, Pricing and New 2026 Developments
In 2026, international insurers continue expanding benefits. Allianz Partners launched its new Allianz Care plan range (Base, Enhanced, Signature) in late 2025, aimed at EU/UK expats. These Core plans include private hospital rooms and repatriation by default, and add-ons like dental or outpatient care can be selected. Allianz’s move reflects a broader industry shift toward simpler tier structures with rich baseline coverage. Similarly, Cigna Global maintains its modular approach, allowing expats to mix-and-match inpatient, outpatient, and other “mini-medical” modules on top of its Silver/Gold/Platinum cores. Mental health support has become standard (AXA’s Mind Health service, Allianz’s psychological therapy with no waiting). Telemedicine (virtual doctor consultations) is nearly universal in 2026, with most insurers offering 24/7 telehealth at no extra cost.
Pricing has risen due to global medical inflation. Average adult premiums for comprehensive global plans often range from a few hundred to over $1,000 per month, depending on age and country of cover (for context, private insurance in Spain averaged €58/month in 2025 for locals; expats pay more). High-risk or older buyers face higher rates. Notably, pandemic lessons have pushed some insurers to broaden cover (e.g. fewer COVID exclusions) and emphasize wellness (vaccinations, telehealth checkups).
Visa & Residency Insurance Requirements by Country
Long-stay visas across Europe mandate proof of health insurance. The exact rules vary:
Germany: All residents must have health cover. Non-EU visa applicants need private travel/visa insurance (min. €30K) for the first 3–6 months. Employees earning below €77,400 (2026) must join public GKV; above that can choose public or private.
France: Long-stay visa (VLS-T up to 6mo) requires valid health insurance for visa duration. UK nationals with GHIC/EHIC are accepted; others need private Schengen-compliant cover (≥€30K). For stays >180d (VLS-TS), valid S1 (EU/UK) or comprehensive private insurance (covering all medical costs) is required.
Spain: Private health insurance with full coverage of expenses (like public SNS) is mandatory for most long-stay visas and residency. Public healthcare (SNS) cannot be used until resident; S1 certificate is accepted for EU/UK retirees. Policies must have no excess and must meet consular wordings.
Netherlands: Short stay (Schengen visa) entrants need €30K travel insurance covering medical and repatriation. Residents (stay >183 days) must take Dutch basic health insurance (basisverzekering) within 4 months. Posted workers or those without economic ties can use international private insurance for up to 1 year.
Italy: Non-EU visa applicants must buy private insurance or a Schengen policy for visa (min. €30K). All workers (with Italian contract) must enroll in Italy’s SSN public system. Others (students, retirees) may voluntarily join SSN (annual fee) or keep private plans. UK nationals post-Brexit need private cover initially; they can later register for SSN.
UK (post-Brexit): For visas >6 months, applicants pay the UK’s Immigration Health Surcharge (IHS) (e.g. £1,035/yr) instead of showing separate insurance. Short stays (≤6mo) do not require surcharge. IHS grants NHS care access (no upfront private premium needed). The UK no longer recognizes EHIC; new arrivals get a GHIC only for short visits.
These rules mean most expats must secure insurance before arrival. For example, a non-EU moving to Germany must show private insurance to get a visa, whereas an EU citizen uses an EHIC/GHIC temporarily. The EU’s 2024 Visa Code reinforces the minimum €30,000 medical cover for Schengen visas; these requirements have not eased in 2026.
Expat Health Insurance Plan Comparison
While specifics vary by plan and individual, common features to consider when comparing top expat plans include hospitalisation coverage, outpatient care (clinic visits, prescriptions), dental/vision add-ons, maternity benefits, provider networks, and service quality. All plans cover hospitalisation, but outpatient, dental/vision, and maternity are optional add-ons.
| Feature | Cigna Global | Allianz Care / Partners | AXA Global Healthcare | Bupa Global | Others (e.g., William Russell, IMG) |
|---|---|---|---|---|---|
| Core Plans | Silver / Gold / Platinum | Base / Enhanced / Signature | Foundation / Core / Essential / Prestige | Major / Select / Premier / Elite | Tiered (e.g. Gold/Silver equivalents) |
| Geographic Coverage | Worldwide (option to exclude USA) | Worldwide with EU/UK focus | Worldwide (option to carve out USA) | Worldwide/Regional options | Worldwide (often USA-optional) |
| Provider Network | ~1.5M providers worldwide | ~1M providers (Allianz network) | 2M+ global providers | Large direct-billing network | Varies; many have global affiliations |
| Mental Health Support | Add-on modules available | Core plans include some care; optional psychiatry | Free 24/7 mental health “Mind Health” service | Included (with therapy, retreats) | Usually included or available as add-on |
| Emergency Evacuation | Included (inpatient plans) | Included in all plans | Included | Included (all levels) | Included in most international plans |
| Typical Cost (Premium) | $$$–$$$$ depending on age/cover | $$$–$$$$ (digital quotes) | $$$–$$$$ (higher for older ages) | $$$–$$$$ (depending on region) | $$$ (WR higher-end), $$ (IMG mid-range) |
| Unique Perks | Highly customizable, 50+ languages support | New digital tools, EU-focused enhancements | Strong digital tools, fast claims (80% in 48h) | Lifetime renewability, wellness checks | Outpatient-heavy; some low-cost plans |
Choosing the best plan involves trade-offs. Cigna is known for flexibility and network size. Allianz Care’s new plans simplify choices while adding benefits (maternity in enhanced plans). AXA offers robust global coverage with English support and direct billing. Bupa’s high-end Elite includes evacuation and alternative therapies. Brokers like William Russell emphasize wellness and speed of care for families/digital nomads. For budget-minded expats, IMG/Globality and GeoBlue (US-focused) can be attractive. Always compare quotes: expat brokers and aggregators can match your profile to the optimal insurer and plan.
Country Highlights & Requirements
Below are key notes for major destinations as of 2026:
Germany: Everyone must have insurance. Non-EU visa holders need private cover for 3–6 months when applying (often a Schengen-visa type policy). Once in Germany, employed expats earning under €77,400/year are required to join public GKV; higher earners may opt for private PKV. EHIC/GHIC holders from EU/UK can access care short-term, but long-term residents must register with GKV/PKV promptly.
France: Long-stay visas (over 90d) require health insurance. Short-term EU/UK visitors can use EHIC/GHIC, but visa applicants must show either GHIC (for Brits) or a travel policy ≥€30K. Family/work visas (VLS-TS) need year-long cover: EU citizens transfer coverage via an S1 form; non-EU must buy comprehensive expat insurance (no copay, covers all care). After 3 months in France, expats generally enroll in Sécurité Sociale and take a supplemental mutuelle for extra costs.
Spain: Private insurance is mandatory for most non-EU residents. Spanish consulates require proof of full medical expense coverage (no high deductibles, no waiting periods) for visas and residency permits. Some visas allow EHIC/GHIC use, but most expats buy a Spanish-compliant policy. Once on residency, foreigners may join the Spanish system and often supplement with private dental insurance.
Netherlands: All residents staying >183 days must take Dutch basic insurance by month 4. Students or short-term workers may initially use private international plans. For visa applicants, ≥€30K travel insurance is required. EU/EEA travelers use EHIC normally; British travelers can use GHIC for up to 180 days.
Italy: Foreign workers must enroll in the Italian NHS (SSN) via their employer. Non-EU visitors applying for a visa need private or Schengen travel insurance (min €30K). Students and retirees usually have voluntary SSN registration or private policies. UK nationals now require private cover for visas, though once residents they can opt into SSN.
United Kingdom (post-Brexit): Long-term visa applicants (work, study, family) pay the Immigration Health Surcharge (IHS) instead of a separate insurance policy. The IHS grants access to the NHS, so no additional travel insurance is needed for visa approval. Short visits (<6 months) do not require IHS.