International health insurance without having a permanent residence?

Question

Hey Nomads!
I’m a Swiss Citizen but full time traveler (living a few month there and there) and therefore don’t have a permanent residence/home anywhere in the world.
For this reason, I’m as well not registered in Switzerland and therefore don’t have medical care since I would have to pay at least 200$ monthly for medical care which I won’t use since I’m not living there.
As a in Switzerland unregistered Swiss Citizen I don’t have medical care in Switzerland but, however based on Swiss Law I’m always allowed to return to Switzerland, register and then get medical coverage (f.e. in a medical emergency).
So now I was looking for both, an international health insurance with good coverage and an additional travel insurance for my trips. Unfortunately every insurance I check, I got asked for a permanent residence - which I don’t have and don’t want to. So I don’t know what to fill out and if I still can get insurance without having a permanent residence.
I was wondering if there are any nomads here with a similar situation like me and (not registered anywhere and without a permanent residence)? If so, what health insurance, travel insurance you have and where?
PS. As well I’m not sure if it is kind of illegal not having a permanent residence anywhere plus where do I have to pay taxes?
Would be extremely grateful for any help on those matters - thanks so much!

fabyliechti · Accepted Answer

@flyonthewall
Many thanks for those helpful informations. The purpose of a permanent address I understand now better. However, most of the insurances I contacted say that they can’t give me coverage as they need a permanent residency.
Or, f.e. “World Nomads” stated: “We define your country of permanent residence as the country where you have your permanent home or principal establishment and to where, whenever you are absent, you intend to return.”
So, yes, I would want to return to Switzerland in case of a medical emergency but no, I don’t have a permanent home and also not a principal establishment, so I think I don’t classify? I asked World Nomads further but they said that it’s up to me to decide if I classify as a permanent resident of Switzerland or not and they can’t give me any advice on this.
Furthermore, they said that World Nomads is not a health insurance policy. It will not cover all of my medical expenses, particularly for medical treatment not considered necessary by our medical specialists.
Anyway, I only read bad reviews about World Nomads so I guess I’m not sure if this is the right insurance company. Do you might know of any international health insurance which would suit for my situation?

alex_vt · Answer

@fabyliechti try https://www.worldnomads.com/travel-insurance/
While I haven’t used this service myself, it was recommended to me by a friend who travelled in Germany for 3 months. It covers health and travel related expenses, and it is cheaper than your $200 a month bill back home.

pri143u · Answer

I didn’t read all the above comments, but Cigna Insurance offers a very comprehensive build your own plan option and they seemed to be affordable. They also never asked me for a permanent residence, just my country of citizenship. Plus their span of worldwide coverage is great!

fabyliechti · Answer

@fippu82 Thanks, Phil, for sharing your opinion and experiences. After being in contact with several international health and travel insurances, I finally got confirmed that I qualify for being Switzerland as my “permanent residence” and I can get insured. Even I’m un-registered as that didn’t matter to them. I also gave them the address of my parents and that was fine. It was World Nomads, BUPA, and IMG Europe who confirmed me that this is OK.
But this solved just the “permanent residence” question for being able to make a policy with the above mentioned travel insurances. As for the international health insurance, in fact, there was no insurance company who were able to insure me (I’m still in contact with CIGNA though and have no definite answer yet). The reason is that my “permanent residence country” is Switzerland and none of the insurances were allowed to make a policy with this country since their product didn’t comply with LAMal (Basic health insurance is compulsory in Switzerland and governed by federal law called LAMal).
However, how you suggested, I think too that I will be covered enough with “just” a travel insurance plus buying an additional “guest insurance” when I’m in Switzerland.
So, for my next trip I just bought a travel insurance with World Nomads. BUPA was a lot more expensive actually (was surprised because everybody is saying World Nomads is more expensive than BUPA?). I haven’t got a quote from IMG Europe, so I don’t know if it would have been cheaper/more expensive but the website was not so user-friendly as World Nomads/BUPA, so I went with World Nomads.
I just came back from Chiang Mai, currently staying in Zurich since I have to finish some business here and then I’ll go to Lisbon. And you?
Also, I wanna thank you so much for all those informations and details you provided me, it actually really helped me a lot - very much appreciated!
Faby
PS. If you like, let’s connect on Insta (if you have) http://instagram.com/fabyliechti

fabyliechti · Answer

@fippu82 Thank you, Philippe, for all those informations. It’s so nice to meet another Swiss Nomad.  Well, that’s indeed really interesting and helps me lot further. I’ve never actually considered only to buy a “travel insurance” but you made me think about it. Of course that would make it a lot easier. However, what if I’m traveling in a country and get sick and need to go see a doctor? I guess this won’t be covered? Or how do you handle that?
Very good tip about the guest insurance in Switzerland and REGA!
In regards of World Nomads, when I contacted them, they told me - on my question if I qualify being a permanent resident of Switzerland - that it’s up to me to decide if I classify as a permanent resident of Switzerland based on the criteria they’ve sent me as I need to meet “ALL the criteria listed in the email” (see below). They we’re actually unable to give me any advice on this.
Because I need to meet ALL the criteria I got really confused as by reading through them, I don’t think qualify. Here the info which was sent to me:
Your country of residence is:

the country you’d want to be repatriated back to if there was a medical emergency during your travels which meant you required ongoing medical care. (yes, thats clearly Switzerland)
In your country of residence you’re expected to have access to private or public medical coverage (yes but first I would re-register again)
a residential address/home (NO, i don’t have that and thats why I think I don’t classify)
as well as a visa/passport that allows you to leave and enter the country without restrictions. (yes, I have)

In the policy wording for Switzerland (https://www2.worldnomads.com/policy_wording.aspx?pid=6966e36eaf0b4343934b208b915bbfef) "we define your country of permanent residence as the country where you have your permanent home (no, I don’t have this permanent home) or principal establishment (no, don’t have either) and to where, whenever you are absent, you intend to return (yes, that would be Switzerland).
So after reading all that, I think I’m not qualified to make a travel insurance with World Nomads since I don’t meet ALL of their criteria. Or what do you think, @fippu82?

replay · Answer

@fabyliechti  Thx for asking that question. I’m in the exact same situation: Swiss citizen without residency.
As of yet I’m using Cigna Global, as my residency I just gave them the address of a friend in Switzerland, but I am quite worried that once I actually need them they’ll use that as an excuse to not pay anything.
Due to CRS (Common Reporting Standard) being introduced in Switzerland in 2018 I’m planning to get a residency in an “easy” country with territorial income tax like Paraguay and file taxes there. I don’t know how Swiss banks will handle clients that have no tax residency once CRS is active, but I prefer not to find out. That will also allow me to put the health insurance on that address without giving them excuses to not pay, because I’ll be able to proof that this is my official residency.
As as side node, I’d never trust anything an insurance tells you on the phone. I’ve had cases (with another insurance) where they’ve promised me anything I asked for, but once it came down to paying the reply was “there’s a clause XYZ in the contract”. My conclusion is: read the contract and rely on nothing else than what’s written there 
Regarding your second question:
As far as I know it’s not illegal to not have a tax residency (I’ve been doing it for years). I have a confirmation from the Swiss tax authorities telling me I do not need to pay taxes as long as I’m not a resident, which is kind of exceptional because many other countries would require you to pay taxes to the country of your citizenship if you don’t file them somewhere else, but you can run into trouble when doing stuff like opening bank accounts / companies or trying to get a driving license. As mentioned above, starting from 2018 Switzerland will start implementing CRS which might change things, so I think it’s better to get all the residency stuff sorted before that: https://en.wikipedia.org/wiki/Common_Reporting_Standard
What is illegal in most countries is to work on a tourist visa (which I assume you do).
Furthermore, if you stay in any of the Schengen countries for more than 3 Months you are required to register as a resident, in some countries you can be fined for not doing so. And I’ve “heard” from unreliable sources that if you stay within the Schengen area for more than half of a year you’re technically required to register as a resident in any one of the Schengen countries, that’s to prevent you from going forth and back between a bunch of them to avoid getting taxed, but I’ve never heard of this being enforced.

lopesrosanna · Answer

Check https://www.truetraveller.com as well, similar to Worldnomads

flyonthewall · Answer

The permanent address question is usually because a lot of international travel insurances will ship you back to your home country if that works out cheaper. Fine print alert: Most international travel insurance policies are what you call “secondary insurance policies” they are sort of an insurance of an insurance.
So if you put down your Swiss address, for a high cost situation, they might decide to “transport” you back to Switzerland for treatment (where like you said you could re-register and get treated for free…) - that’s where your “primary” Swiss coverage kicks in.
This varies in every situation and depends on your country of origin, where you are when you need treatment, the severity, etc. etc. etc.
Putting down your “permanent” address in your international health insurance as Switzerland (a parent or close relatives address) should not affect your tax situation. It’s just where the health insurance folks send their policy letters, and will ship you back to, if they have/want to.

loveniniq · Answer

@fabyliechti u r welcome! keep me posted on this; would love to get some intelligence about it  sorry that i ask bit you made me curious: what’s your job? Best, Nina

orca · Answer

My colleague here lives in the US, Switzerland and Costa Rica he swears by http://www.imglobal.com/en/index.aspx it is not over dear for a high level of coverage at US$332 / £250 a month for him and his partner. As far as ages he is 59 the girlfriend is 37.

fippu82 · Answer

Hey Faby
I was in the EXACT same situation as you a good half a year ago. I say exact because I’m Swiss too, am unregistered and have no permanent address anymore and neither a registered business. I was also puzzled about this permanent address question even by insurances like World Nomads which call themselves insurance for nomads like we are. In the end I came to the same conclusions as already mentioned by others here: In case we would need any long term treatment, they want to be able to ship us back to a country where we would get insurance covered by the state or a private company which has to take us for the mandatory health insurance by law, like in Switzerland. I somehow understand this, as otherwise it wouldn’t make sense that one pays 60$/month for World Nomads, but 200-300 CHF a month for a Swiss health insurance (which in fact cover more than World Nomads which is actually a travel insurance covering emergency treatment expenses only, but that’s all what you really need).
You probably would anyway agree and ask to be treated back in your home country (where family and friends probably live) in very severe cases, so I understand the question of permanent residency more as the “theoretical” country of residence or actually the country which you are a citizen in.
So I signed up for World Nomads and feel I’m covered enough with them, but have luckily never used them. knock on wood. The only annoying thing is that when I visit my home country, I’m not covered and technically would need to buy a monthly so called “guest insurance” (you get them from all major insurances, I checked e.g. with Swica where it costs around 180 CHF if I remember correctly). Last time I believed in my good fate instead ;-).
As a Swiss I can additionally recommend you to pay as little as 30 CHF a year to become a donor of Rega, which would do repatriation from any country by air (they will deal with the health insurance that you would join back in Switzerland to get their cost covered if possible, or cover it themselves if they can’t find an agreement, as a friend’s friend told me who works for them as “air nurse”  ) This would save you lots of time and effort if any time needed.
Hope that helps.
Best,
Philippe

claudi · Answer

I am also a full time traveler and a citizen of Australia. This whole travel or rather health insurance issue is and has been doing my head in…
My understanding now is that unfortunately the policies of insurers do not cater for nomads. Our lifestyle does not fit into their boxes and that is why you/we run into those difficulties. The likes of WorldNomads just use fancy/glamorous terms in order to attract customers but they all usually rely on global underwriters like Allianz etc.
As already mentioned form the insurers perspective we all have to have a country of residency so that they can ship us back when medical treatment becomes too expensive for them. Plus you/we will only be covered for emergency treatment and not for regular check ups etc but those are ok to good and inexpensive in many countries around the world nowadays. Plus they exclude pre-existing conditions or make you pay dearly for cover. Also as already mentioned you are covered everywhere but in your country of residence which causes issues when we/you go back for a visit unless there is public health insurance (like Medicare in Australia).
The issue that has not been mentioned yet and to which I have not found a solution is that most travel (health) insurers (minus the expensive expat ones) will only cover you for one or two years which means for now it looks like I might have to go back every two years in order to buy a new insurance. Even though I might consider going back home for a little while every now and again anyway I hate being dictated into that by the necessity of acquiring an insurance policy. Keen to hear your thoughts and possible solutions on this!!!

fippu82 · Answer

Happy to help, @fabyliechti ! Yes, WorldNomads.com is a travel insurance, but that doesn’t mean they only pay for delayed flight or things like that, but also for medical expenses in case of accidents/sickness. I was also confused first about the term “travel insucrance”, as we normally have the word “health insurance” in mind. But this can be read on their website:
You need Medical help for sudden illness or injury:
We cover emergency overseas medical treatment including treatment in a clinic or hospital, plus medicines and physiotherapy as prescribed by your treating Doctor to get you well and keep you travelling.
So your question if your doctor’s visit is covered should be answered by this. In short: Yes it is 
And yes, the criteria in the terms are confusing. Especially for an insurance for long time travelers. Quite silly I would say…  But hey, it’s an insurance, and that’s still a dry business which is based completely on policies, even though they have a modern branding. So I wouldn’t take the terms so exactly and literally. For the residential address I simply gave them the address of one of my parents.  As simple as that. It could also be a friend’s home. I see no reason that this would make you not eligible for the insurance. After all it could really be that you live with your parents or a friend (at least for the first weeks that is also likely). And the terms don’t ask for a registration in your home country. That’s irrelevant (for the insurer).
And yes, if you had to abort your long-term traveling and return back home for a longer time and treatment, you could register as resident as well as with a health insurance which legally would have to cover you from day 1 in Switzerland.  This is what I was told by the friend at REGA based on her experience with their patients (often pensioners who have to come back from Thailand  ). So take my advice and information without guarantee.
I’m curious, in which country(ies) are you mostly or currently staying?
Phil

dannybooboo · Answer

@gigigriffis I’ve just finished 3 full (I mean, 8 hour days) of research for medical insurance and I’ve also decided on GeoBlue. The only con of thier coverage is they don’t provide complimentary 30 days emergency only cover in the US so I’ll have to get another insurance while I’m in the US, but that’s not a big deal. I evaluated 7 insurers based on recommendations from research related to digital nomad medical insurers and if anyone wants to see my spreadsheet, just send me an email drusty87@yahoo.com or ping me here.

fabyliechti · Answer

@lopesrosanna I contacted them but unfortunately they are only able to insure residents of the UK and other EEA countries. Thanks anyway for the tip.

fabyliechti · Answer

@nina Thank you, Nina. I contacted CIGNA a few days ago and currently awaiting their reply. As for taxes, I’m not staying anywhere longer than 3 month, don’t have an official residency anywhere and also don’t have a registered business. So far no insurance I contacted (Allianz, World Nomads, True Traveller, Aetna) wants to cover me but I’m still awaiting answers of other insurances like BUPA, Clements and Cigna. Hope to find an insurance soon.  Thanks for your help anyway!

fabyliechti · Answer

@melvillevt Thank you very much for this recommendation. I’m currently in contact with World Nomads. Before contacting them I only read negative reviews so I was unsure if I should contact them but, however I thought I give it a try. Now, the informations they’re providing me aren’t very helpful, indeed, so I guess I’m going to look for other options. However, thanks anyway for the recommendation, I appreciate!

fabyliechti · Answer

@nina Yes sure, I will.  I’m a retired professional dancer and choreographer, creating digital training programs for women through my online school. The school is not yet launched though. And what’s your job?

mari_travels · Answer

Hi, I’m in a similar situation now.
I also spend around 3 months per country, and now I’m looking to get an international health insurance that will cover all medical treatments, instead of just a travel insurance for emergencies. I’m from Venezuela, and the idea that the travel insurance will just ship me back to my home country to get treated for something major is horrific at the moment.
So, I would like to know if anyone here had used and made claims with: Integra Global, IMG, or Cigna Global. I need some honest reviews, the ok, the good, the ugly.
I was leaning towards Integra Global but I couldn’t find 1 single costumer review about the company claim process, which I think is really weird and fishy for a company that has 10 years in the market.
IMG has a couple of really bad reviews online that make me doubt, and Cigna (the only one that seems to have good reviews online regarding the claiming process) only offers “inpatient” care in their core plan, and adding the Outpatient option doubles the prices and makes it super expensive. So, I’m torn.
Please help   Thanks in advance!

fabyliechti · Answer

@lopesrosanna Cool, thanks a lot.

fabyliechti · Answer

@ORCA Thank you very much for this recommendation. I also contacted them a few days ago and like almost every insurance they ask me where would be the place I reside / stay mostly as this would be what they consider to be my residence country.
Well, as of today I have no clue about where I’m gonna stay mostly because my trips are more or less planned spontaneous. But, for sure I will travel regularly to Switzerland to visit family. So maybe I’m gonna be there 3-4 month a year maximum (don’t know exactly). But then they said, they do not provide coverage in the location I selected (Switzerland) as my residence country. 
I’m still in contact with them, so I will see what will be the outcome.

ahshiman · Answer

hi, I would actually love to see that spreadsheet if you don’t mind! I went with World Nomads in the past but would like to see what other options are out there.

fabyliechti · Answer

Hey @Claudi, yes, I understand completely. It caused me a real headache.  And yes, it’s indeed true that the digital nomad lifestyle does not (yet) fit into the boxes of insurances, governments & Co. However, there are solutions somehow, it’s just a bit difficult and time consuming to find them. It’s interesting to hear your knowledge and experiences, thanks for sharing. And yes, I totally understand that insurances need to have a country of residence in case of repatriation.
The issue with the cover duration I haven’t thought about yet and it’s definitely an important point which I’ll have to go into as well. As of today, unfortunately I don’t have any knowledge or experience about this topic but maybe other nomads from this forum?

bananaeatsmonkey · Answer

From my experience, if you are young, have a healthy lifestyle (have habit of working out  weekly etc), and you travel often…you are better off with pay per use than insurance.
Personally, I’m from US, with my income, the health insurance I have to pay is very unfair. So what I do is I stop by Singapore or Taiwan for my annual check up etc. You get better health service and lower cost if opt-out insurance.

thierrymeier_ · Answer

As a Swiss digital nomad who’s currently in the exact same boat as you find yourself I can honestly say that the information in this thread has been extremely valuable. Thanks so much for this.
I am curious about one more thing! I currently hold a “Krankentaggeldversicherung” which would pay me CHF 5’750 every month after the first 90 days after becoming permanently/temporarily invalid for a total of two years. My father has actually suggested to do this, since he made a good case for it being useful given that I am self-employed and I’d want some extra cash in case shit hits the fan.
Do you happen to know if it is possible to have a KTG contract with an insurer in Switzerland without a permanent residency? Furthermore, is something like that possible outside of Switzerland through a Nomad insurer?
Curious about that one.

loveniniq · Answer

look into cigna. they are internationally recognized, cheap and i think theY dont make an issue of this residency problem. they are a full on health provider. in terms of tax: u pay income tax where ur official residency is, i.e. usually where u stay longer than 182 days. if u run a business, it should be registered anywhere. for that, u gotta pay sales tax, which greatly varies in value depending on tje state. hope that helped!

gigigriffis · Answer

Hi Mari,
I used IMG and had a terrible experience. They ignored my claims and never even acknowledged them even though I wrote to them over and over again to confirm receipt. I would not recommend them.
Now I’m with GeoBlue, who I love. I don’t know if you have looked into them, but they’ve been great to me. I pay about $160 per month (so a bit more than IMG), but they have helped me set up two appointments so far (in six months of having the insurance), both with competent English-speaking doctors, and both times they set up direct billing and paid the full bill. I didn’t owe anything. They’re great.

fippu82 · Answer

PS: Just another thought about the difference health vs. travel insurance: a health insurance could pay for preventative measures, gyms, glasses and also for regular health checkups etc. Of course, this you don’t get from a travel insurance like World Nomads. In my case I happily pay these things out of my own pocket (as it’s anyway cheap in Asia) instead of paying the high fees of a full fledged health insurance like we are used to. I just did a checkup in Bangkok for not much more than 100 US$! Would be at least five times more back home. And the quality/cleanliness was very good!

loveniniq · Answer

Hi @fabyliechti, sounds awesome!
I am a Marketing & Business strategist and starting to consult & help others with their strategy (:

fabyliechti · Answer

@fippu82 Yeah, same here. I’m also fine paying for those things out of my pocket. That’s awesome, yes, in Thailand hospitals and doctors are very good, indeed.

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