UK private medical insurance covers treatment in the UK — it doesn't follow employees abroad. Staff based overseas need international PMI (iPMI), a separate product typically costing 2–4x a UK premium. Most mixed teams run a split scheme: standard group PMI (~£57/head/month average) for UK staff, an iPMI policy for overseas staff, often with the same insurer group for simpler admin.
- ✓UK group PMI funds UK treatment only — an employee living abroad effectively can't use it.
- ✓International PMI is a different product, typically 2–4x the cost of UK cover per head.
- ✓The standard answer is a split scheme: UK PMI for UK staff, iPMI for the overseas contingent.
The core fact: UK PMI stops at the border
UK private medical insurance is built around UK private hospitals, UK consultants and UK pricing. Policies fund eligible treatment in the UK; at most, some include limited emergency cover for short trips abroad. An employee who has relocated to Lisbon or Dubai can't use a UK group policy in any meaningful way — they'd have to fly back for every consultation, scan and operation, which insurers neither expect nor, in many cases, permit once the employee is no longer UK-resident.
This catches companies in a specific, increasingly common way: a UK business hires remote staff abroad, or lets a UK employee move overseas, and simply leaves them on the group PMI scheme. The premium keeps being paid; the cover has quietly become worthless to that person. Worse, insurers typically require scheme members to be UK residents — an unnoticed move abroad can mean claims are declined at exactly the wrong moment.
International PMI: a genuinely different product
International private medical insurance (iPMI) is not 'UK PMI with a bigger map'. It's designed for people living outside their home country: cover across a chosen region (typically 'worldwide excluding USA' or 'worldwide'), direct settlement with hospitals abroad, evacuation and repatriation benefits, and often richer cores — outpatient, chronic condition and maternity options that UK PMI doesn't attempt. Providers include Bupa Global, AXA Global Healthcare, Allianz, Cigna Global and April — note these are separate arms from the domestic insurers, with separate products and pricing.
| UK group PMI | International PMI | |
|---|---|---|
| Where treatment is covered | UK | Chosen region or worldwide |
| Typical cost per head | £35–£110/month (avg ~£57) | Roughly 2–4x UK equivalents |
| Evacuation/repatriation | No | Usually included or optional |
| Chronic conditions | Generally excluded | Often covered on fuller plans |
| USA cover | No | Optional — and expensive |
The price gap is structural: iPMI prices reflect medical costs in the covered region, broader benefits, and the risks of cross-border care. Budget 2–4x a UK premium per overseas head as a planning figure — more if US cover is included, which can double the price again.
The split-scheme approach: how mixed teams actually do it
The standard solution is unglamorous and works: run two schemes. UK staff go on a normal group PMI policy at normal UK rates; the overseas contingent goes on a group (or a handful of individual) iPMI policies. Practical notes from how these get built:
- Same insurer group, simpler life. Pairing Bupa with Bupa Global, or AXA Health with AXA Global Healthcare, gives one relationship and broadly aligned benefit philosophies — though it's still two contracts and two renewals.
- Small overseas headcounts are fine. Group iPMI typically starts around 2–3 members; below that, individual iPMI policies per employee work, sometimes employer-paid.
- Match intent, not geography. A UK employee on a 6-month secondment may be covered by extending UK arrangements plus travel cover; someone permanently based abroad needs iPMI. The dividing line is residence, not passport.
- Benefit parity is a choice, not a default. An iPMI plan matching UK benefit levels is affordable; matching UK *premiums* is not. Decide openly whether overseas staff get equivalent cover at higher cost, or a leaner tier.
Cover the UK team, plan the rest
Remote workers abroad: the honestly messy bit
The clean cases are secondments and established overseas offices. The messy one is the modern default: a developer in Spain, a designer in Poland, a customer-success hire in South Africa — often engaged through an employer-of-record (EOR) rather than a local entity. Here the health cover question tangles with employment structure, and the answers vary too much for tidy rules.
Points that generally hold. If staff are engaged via an EOR, the EOR is the legal employer and often offers local health plans — sometimes the simplest route, though quality varies by country. If they're contractors, providing insurance directly can complicate employment-status questions; many companies instead pay a benefits stipend and let the contractor buy their own cover. Local rules differ on whether employer-paid iPMI is taxable, whether local statutory health contributions still apply, and even whether iPMI satisfies visa requirements. This is one area where 'generally' and 'typically' are doing real work — get country-specific advice before promising anyone cover.
One more trap: some countries require residents to hold locally admitted insurance, which a global iPMI policy may or may not satisfy. Your iPMI provider or broker can confirm country by country.
Getting the UK half right while you sort the rest
None of the overseas complexity should delay the straightforward half: your UK staff can be covered this month on a standard group scheme from 2 employees upwards, at £35–£110 a head with the usual tax treatment (corporation-tax deductible, BIK for employees, Class 1A NIC at 15%). Overseas staff on iPMI are outside the UK BIK system but may face local equivalents — another accountant conversation.
Our whole-of-market comparison covers the UK scheme directly, and for mixed teams we can point the overseas piece at the right international arms — Bupa Global, AXA Global Healthcare and peers — so the two halves land as one coherent package rather than an afterthought. Start with the UK small business scheme, and see our guides to startup health cover and cover for non-UK residents for adjacent questions.
Frequently asked questions
Does UK company health insurance cover employees living abroad?
No — UK PMI funds eligible treatment in the UK, with at most limited emergency cover on short trips. An employee based overseas can't practically use it, and most insurers require scheme members to be UK residents, so cover for someone who has moved abroad may not respond at all.
What insurance do overseas employees of a UK company need?
International private medical insurance (iPMI) — a separate product covering treatment in the employee's region or worldwide, with direct hospital settlement and usually evacuation and repatriation. Providers include Bupa Global, AXA Global Healthcare, Allianz and Cigna Global. Alternatively, local plans via an employer-of-record can work.
How much does international PMI cost compared with UK cover?
Typically 2–4 times the equivalent UK premium per head, reflecting regional medical costs and broader benefits — so an employee costing £57 a month in the UK might cost £120–£230+ abroad, and adding USA cover can double it again. Region, age and plan richness drive the range.
What is a split scheme for UK and overseas staff?
Two policies run in parallel: standard group PMI for UK-based staff at UK rates, and an iPMI policy (group from around 2–3 members, or individual policies) for the overseas contingent. Many companies pair domestic and global arms of the same insurer — Bupa with Bupa Global, AXA Health with AXA Global Healthcare — for simpler admin.
Can remote workers abroad stay on the UK group health scheme?
Generally not once they're genuinely resident abroad — insurers' residency rules mean the cover may not respond, and the treatment network is in the wrong country anyway. Short business trips and brief stints are usually fine; a permanent or long-term move means switching that person to iPMI or a local plan.
How do you insure staff hired through an employer of record (EOR)?
The EOR is the legal employer, and most offer local health plans in each country — often the simplest route, though quality varies. Alternatively the client company funds iPMI or a stipend. Tax treatment and whether cover meets local requirements differ by country, so take country-specific advice.
Does an employee on secondment abroad need international health insurance?
It depends on length and destination. Short secondments are often handled with business travel cover plus the UK policy; longer or open-ended postings need iPMI, and some countries require locally admitted insurance regardless. The practical dividing line is where the employee is genuinely resident, not their passport.
Is international PMI for overseas staff a UK benefit in kind?
Overseas employees outside UK payroll generally sit outside the UK BIK system, but local equivalents often apply — many countries tax employer-paid health cover in their own way, and rules vary widely. UK-payroll employees on iPMI (such as seconded staff) generally remain within UK BIK rules. Confirm per country with your accountant.
Can a small company get group international health insurance for two or three overseas staff?
Yes. Group iPMI schemes typically start around 2–3 members, and below that individual iPMI policies per employee work fine, employer-paid. Budget roughly 2–4x UK per-head rates. Small overseas contingents are entirely normal — it's how most UK companies with a few foreign hires handle cover.
Should overseas staff get the same level of health cover as UK staff?
It's a deliberate choice. Matching benefit levels abroad is achievable but costs 2–4x per head, so some employers run benefit parity at higher spend while others give overseas staff a leaner iPMI tier or a local plan. Decide openly and communicate it — accidental inequality is what breeds resentment.