Health cover starts with where the employee lives

US group health plans are built around American networks and rules. California’s small-group law, for instance, is written for employers whose staff mostly work in California, so a designer in Toronto falls well outside what such a plan was designed to do. For someone living abroad, their home country answers most of the questions first: whether they already belong to a public system, whether a local employer must enroll them in a scheme, and which insurers may legally cover them there.

So start with a short note for each person: the country and city, how they are employed, and who in the household needs cover. This guide is part of our employee benefits section, and staff who live in the US but outside your home state are covered in health insurance for remote employees in other states.

Public systems are the base layer

Most countries where US companies hire remotely run a public system that people join by living or working there. Canada runs resident-based cover through each province. The NHS in the UK serves residents and visa holders who have paid the immigration health surcharge. The Health Service Executive in Ireland provides public services to anyone ordinarily resident. SUS in Brazil is open to everyone in the country at no charge, and Australia has Medicare.

These sit underneath whatever benefit you add, and they change what a private plan is for. In Canada, drugs, dental and vision care are publicly covered only for certain groups, so private cover often fills those gaps. In the UK, an international plan adds private and faster care on top of the NHS rather than standing in for it.

Schemes a local employer pays into

Some countries go further and tie health cover to employment itself. In Germany, health insurance is generally compulsory for everyone who lives there, and employees earning below a set threshold belong to statutory health insurance, run by competing sickness funds. France covers anyone working there under the national scheme from the first day, and every private employer must also offer a company complementary plan, the mutuelle, paying at least half of its cost. Japan requires residents to enroll in public health insurance.

In Mexico, an employer registers with IMSS and enrolls each worker. In the Philippines, employer remittances to PhilHealth are mandatory for employees. India requires ESI registration for staff below its wage ceiling at covered establishments. Singapore gives citizens and permanent residents MediShield Life automatically, and in the Netherlands everyone who lives or works in the country must hold standard health insurance from a Dutch insurer, which the person buys for themselves. Each duty falls on whoever is the legal employer locally.

Where an international plan fits

An international or global health plan follows a person across borders, and it usually plays one of two roles. In most of the countries above it is a top-up: it adds private hospital choice, faster access or care outside the country, while the local scheme stays in place. An international plan cannot replace IMSS enrollment in Mexico, statutory insurance for a compulsorily insured employee in Germany, or PhilHealth for a Filipino employee.

In a smaller group of cases it can be the main cover. Hong Kong has no statutory health insurance, so a global plan works as the employee’s main private cover alongside public hospital access for Eligible Persons. Singapore sets no statutory medical insurance mandate for Employment Pass holders, and EOR guides note that India sets none for employees above the ESI wage ceiling.

Local selling rules add a second filter, since many countries let only locally authorized insurers carry on insurance business. The UK requires authorization under its Financial Services and Markets Act, Singapore requires a licence from its Monetary Authority, Ireland limits health insurance business to insurers on the Health Insurance Authority’s register, and Mexico generally bars contracting personal insurance with foreign companies when the insured person is in Mexico. So whether an international plan can be issued to someone in these countries is for the insurer to decide under each country’s rules.

Spouses, children and other dependants

Germany’s statutory insurance covers a non-earning spouse and children at no extra contribution, while private insurance there needs a separate contract for each family member. Japan’s Employees’ Health Insurance can cover financially dependent family living in Japan. IMSS in Mexico lets a worker register a spouse or partner, children, and parents who depend on them and live with them.

Elsewhere family cover is the employer’s choice. In France, extending the mutuelle to dependants is optional, set by the employer or a sector agreement. In Singapore, group medical insurance for the employee, spouse and children, offered to all staff, is not taxable to the employee, while a personal policy the employer pays for is. Tax treatment like this varies by country, so check with a local tax adviser before you settle how a benefit is paid. List each dependant, where they live and any cover they already have.

Who provides cover follows how you hire

A person can work for you abroad in three ways: employed through your own local entity or a direct payroll registration, employed through an employer of record (EOR) that becomes the legal employer, or engaged as an independent contractor. The legal employer enrolls the employee in the local scheme and pays the contributions. A contractor generally arranges and pays for their own cover.

The EOR model has limits in some places, including Singapore for foreign hires, Germany and Spain. Our guide to health coverage for EOR employees and contractors abroad walks through each route.

Country-by-country guides

Each country page covers the public system, what a local employer must provide, whether an international plan replaces or tops up the local scheme, and the usual hiring setups:

Getting an introduction to a benefits partner

When you are ready to look at options, we can introduce you to a benefits partner that handles international and remote-team health coverage. Use the quote form on this page: tell us where your team lives and how many people, and we will pass it to a benefits partner. The partner and the insurer decide eligibility, plans and pricing. Helpful details:

each employee’s country and city
how each person is engaged: your own entity, an EOR or a contract
citizenship or visa status where it changes the answer, such as a Singapore Employment Pass
the dependants to include and where they live
any local scheme each person already belongs to
whether you want a top-up or main cover

For workers’ compensation, employment practices and cyber, see insurance changes for remote teams, the commercial policies we request from insurers.

A few useful answers

Common questions

Can an international health plan replace a country’s public system?

In most countries it cannot: Mexico, Germany, France, Japan and the Philippines make local enrollment compulsory, so a global plan sits on top. In Hong Kong it can be the main cover.

Do remote employees abroad need cover for their families too?

Some public schemes include family automatically, as Germany’s statutory insurance does for a non-earning spouse and children. Others, like the French mutuelle, leave it to the employer.

Why does it matter which insurers may sell in a country?

Many countries allow only locally authorized insurers to carry on insurance business, among them the UK, Singapore, Ireland, Hong Kong and the Philippines. That rule shapes how an international plan is set up for someone living there.

Who enrolls an employee abroad in the local health scheme?

The legal employer does. That is your own entity or payroll registration if you have one, or the employer of record if you hire through one. Independent contractors generally arrange and pay for their own cover.

How does an introduction to a benefits partner work?

Send the quote form with the countries your team lives in and the number of people in each. We pass it on to a benefits partner, who works with the insurer on which plans fit and what each person is eligible for.

International Health Insurance for Remote Employees