Employee Health Coverage Rules by Country: 45-Country Comparison

Latin America and Canada

All eight countries here run a public or mandatory scheme that a local employee joins first, and Canada sits with its neighbours in the Americas. The Latin America guide goes deeper on the region.

In plain terms: a global plan is extra cover in every one of these countries, and six of the eight limit who can sell insurance locally. Mexico, Colombia, Chile and Peru also regulate staffing, which shapes how an employer of record can be used.

Asia-Pacific

This region has the widest spread, from the payroll-based insurance of Japan and South Korea to Hong Kong, where no health insurance scheme exists. See the Asia-Pacific guide for how the fifteen countries compare.

Most countries in this table make the employer pay into a national scheme, so a global plan normally tops it up, and nearly all of them license insurers tightly. Hong Kong, India, Malaysia, Singapore and New Zealand are the exceptions where it can be the main cover, in several of them only for employees with a certain pay level, work pass or visa.

How to read the table

Each row condenses one country guide, and every country name links to that guide. Read the columns this way:

• Public or mandatory scheme is the short name of the public system or compulsory cover a local employee belongs to.
• Employer pays in? Yes means the employer pays its own share, levy or premium toward that scheme, or must buy the required cover. No means the scheme runs on taxes or on the employee’s own contribution, even when the employer deducts that contribution from pay. Varies means the answer turns on the province, the employee’s pay or work pass, or the employer’s size.
• Foreign insurers restricted? Yes means local law requires a licence or authorisation to sell or carry on insurance there. It does not always stop an employee holding a plan bought abroad: Chile, Peru and India, for example, let residents buy cover abroad while unlicensed insurers still cannot sell locally. Spain shows Varies because its limit applies to cover offered for certain visas.
• EOR or staffing limits? Yes means the country licenses, registers, time-limits or bans the supply of workers to another business, or limits what an employer of record may do. Whether a given EOR arrangement falls inside those rules is a question for the provider.
• International plan role shows Top-up where a statutory scheme or a residence-based public health service is the employee’s base cover, so a global plan adds to it. Main cover possible marks countries where, for some or all employees, no compulsory scheme or full residence-based entitlement applies, so a private or international plan can be their main health cover.

Not clear marks a rule that is unsettled or not set out plainly in official guidance. The tables are a starting map, not legal or tax advice, so confirm the rules for your own hire with a local adviser in that country.

Requesting an introduction for a team in several countries

Mithril1 does not sell health plans. When the table has helped you narrow things down, list the countries your people live in, how many work in each, and whether they are on your own payroll, with an employer of record or on contracts. Send that through the quote form on this page and we will hand it to a benefits partner that works on international and remote-team health cover. From there, the partner and the insurer decide who is eligible, which plans are available and how they are priced.

Your US business insurance is a separate conversation. For workers’ compensation or employment practices liability covering a distributed team, we request quotes from insurers, and the insurer decides after reviewing your details.