The survey covers more than 6,400 French expatriates living in over 80 countries, including employees, self-employed professionals, retirees and other internationally mobile profiles. Although 93% of respondents have health cover, more than half have delayed or forgone care they needed.
For brokers and international employee-benefit decision-makers, the findings reinforce an important principle: insurance is only meaningful when people can understand it, afford to use it and navigate healthcare with confidence.
Coverage and confidence at a glance
| Survey finding | What it may indicate | Question for employers and brokers |
|---|---|---|
| 93% have health cover | Most expatriates are formally insured. | Does the policy provide meaningful protection in practice? |
| 53% have delayed or forgone care | Coverage may not remove financial or practical barriers. | Could the plan design discourage employees from seeking treatment? |
| 51% cite insufficient reimbursement | Benefits may not reflect actual healthcare costs. | Are reimbursement limits appropriate for each destination? |
| 48% cite the high cost of care | Upfront payments and out-of-pocket expenses remain significant. | Can direct billing or pre-authorisation reduce financial exposure? |
1. Covered does not always mean expatriates feel protected
The strongest finding from the survey is the gap between the number of expatriates who have health cover and the number who feel able to access care when they need it. According to the Barometer, 53% of expatriates have delayed or forgone necessary care. The two most frequently cited reasons are insufficient reimbursement, mentioned by 51%, and the high cost of care, mentioned by 48%.
This suggests that policy ownership alone is not an adequate measure of protection. Members may still face high out-of-pocket costs, reimbursement limits, exclusions, deductibles or uncertainty about whether a treatment will be covered.
For brokers, a benefits review should therefore test the practical effectiveness of the plan. This means examining not only premiums and benefit schedules, but also the likely financial experience of an employee who needs hospital treatment, specialist care, diagnostic tests or ongoing treatment in their country of assignment.
APRIL International offers flexible international health plans designed to provide access to quality healthcare across different countries and healthcare systems. Depending on the policy and treatment, services such as pre-authorisation, medical case management and direct billing can help members access appropriate care while reducing uncertainty and the need to pay significant costs upfront.
2. Cost clarity is part of effective protection
The Barometer shows that healthcare costs are a significant source of pressure for expatriates. More than half of respondents, 56%, pay over €200 per month for their health cover, while 71% finance their insurance themselves.
Despite this personal financial commitment, 59% say they do not understand healthcare costs, and 19% have received an unexpected medical bill.
For brokers and employers, cost clarity should therefore be treated as part of the benefit itself. Employees need to understand not only the premium, but also what they may have to pay when they receive treatment. This can include deductibles, co-payments, benefit limits, exclusions, usual and customary rate rules and the difference between direct billing and pay-and-claim arrangements.
Clear information should be provided before a medical need arises. Employees should know which providers they can use, when pre-authorisation is required, what documents they need and how reimbursement will be calculated.
APRIL International supports this through clear benefit information and digital tools that allow members to submit and track claims. Where available, direct billing can reduce the need to pay eligible hospital or medical expenses upfront. The Easy Pay Card may also help members manage eligible healthcare payments without having to advance significant amounts themselves, subject to the applicable terms and conditions.
3. Fast access to care does not automatically create confidence
The survey indicates that access to medical appointments is relatively fast for many expatriates. 83% can see a general practitioner within three days, while 79% can obtain a specialist appointment within two weeks.
However, speed alone does not guarantee a positive healthcare experience. 39% rate their access to care as worse than in France, and 21% say they have felt medically at risk while abroad.
These findings show that healthcare access is not only about waiting times or the number of providers in a network. Expatriates must also be able to identify an appropriate healthcare professional, understand the local system, communicate effectively and feel confident about the quality and suitability of the care they receive.
For brokers, this means assessing how members will be guided through unfamiliar healthcare systems. A large provider network may have limited value when employees do not know which facility to choose, whether a provider is appropriate for their condition or whether the treatment will be covered.
APRIL International helps members navigate local healthcare systems through access to an international provider network, provider guidance, teleconsultation services and support in identifying appropriate care. Depending on the plan and medical situation, members may also benefit from medical assistance, case management or a second medical opinion.
4. Clear information and human support create real value
Understanding of international health insurance remains limited. According to the Barometer, no measure of contract understanding scores above 6 out of 10. Repatriation cover is the least understood area, with an average score of just 4.7 out of 10.
Respondents also express a clear demand for wider direct billing, more transparent reimbursement information and access to a human contact when they need help.
This highlights an important issue for benefit decision-makers: a technically comprehensive policy may still fail to deliver value when members do not understand how to use it.
Communication and service pathways should therefore be considered integral parts of the benefit. Employers and brokers should examine whether members receive plain-language onboarding information, whether key exclusions and pre-authorisation requirements are clearly explained and whether there is an accessible escalation route when a medical or claims situation becomes complex.
APRIL International combines digital services with multilingual human support. Members can receive guidance at different stages of their healthcare journey, from finding an appropriate provider and requesting pre-authorisation to submitting documents and tracking a claim.
This combination of technology and human assistance is particularly important in stressful situations, when members may not have the time or confidence to interpret policy documents or navigate a foreign healthcare system alone.
5. Mental-health support remains a significant gap
Mental health is one of the clearest areas of unmet need identified by the survey.
Only 11% of respondents have access to psychological support, while 40% lack access despite potentially needing it. In addition, 12% say their psychological wellbeing has deteriorated since expatriation.
Relocation can involve social isolation, cultural adjustment, professional pressure, family disruption and uncertainty about the future. These pressures can affect employees, accompanying partners, students and other internationally mobile populations.
For brokers and employers, it is not enough for mental-health support to appear as a line in a schedule of benefits. They should assess whether the service is genuinely accessible across borders, available in an appropriate language, culturally suitable and clearly communicated to members.
Depending on the selected plan, APRIL International members may have access to mental-health benefits and remote psychological support. Employers may also consider complementary services such as employee assistance programmes, particularly for internationally mobile employees and their families. Dedicated mental-health support can also be relevant for international students, who may face academic, financial and social pressures while living abroad.
Turning survey findings into practical broker conversations
The Barometer provides brokers with an evidence-led framework for reviewing international health benefits with employers.
| Survey theme | Broker discussion | How APRIL International can help |
|---|---|---|
| Delayed or forgone care | Are reimbursement levels and out-of-pocket costs discouraging treatment? | Flexible plan design, pre-authorisation, medical case management and direct billing. |
| Limited cost understanding | Do employees understand likely expenses and the available claims routes? | Clear benefit information, digital claims tracking, direct billing and the Easy Pay Card. |
| Low confidence in local care | Can members identify suitable providers and navigate the local healthcare system? | Provider guidance, international healthcare networks, teleconsultations and medical support. |
| Poor understanding of benefits | Are onboarding information and escalation routes clear and accessible? | Multilingual human assistance alongside accessible digital services. |
| Limited psychological support | Is mental-health support accessible and usable across countries and languages? | Mental-health benefits, remote psychological support and complementary support services, depending on the selected plan. |
These discussions can help brokers assess whether a benefit programme is performing as intended. They also create opportunities to identify gaps before they affect employee wellbeing, satisfaction or assignment success.
Questions brokers can ask during a benefits review
To address the gaps identified, a practical review might include the following questions:
Could an employee afford to obtain treatment without delaying care?
Are reimbursement levels appropriate for medical costs in each destination?
Do employees understand deductibles, co-payments, limits and exclusions?
Can members easily identify an appropriate healthcare provider?
Is direct billing available for the most significant medical expenses?
Is human support available when a case becomes urgent or complex?
Are mental-health services accessible across countries and languages?
Do employees know how assistance and repatriation benefits work?
Conclusion: international health insurance must work in practice
The 2026 Health Barometer presents a French expatriate population that is widely insured, but not always fully confident in its ability to access and pay for healthcare.
The headline figures are clear: 93% of respondents have health cover, yet 53% have delayed or forgone care. Cost, uncertainty, limited understanding and gaps in psychological support continue to affect the expatriate healthcare experience.
For brokers and international employee-benefit decision-makers, the priority should be to move from a policy-centred approach to a member-centred approach.
Effective international health protection depends not only on the existence of insurance, but also on whether members can understand their benefits, manage their costs, find appropriate care and obtain human support when they need it.
By combining flexible international cover with healthcare navigation, direct billing, digital services and multilingual assistance, APRIL International helps brokers and employers support international mobility with greater clarity and confidence.
