International Health Insurance Companies Compared: Cigna, Bupa, Allianz and AXA
Cigna Global · Bupa Global · Allianz Care · AXA Global Healthcare. Compare 17 policy features including annual limits, deductibles, maternity, evacuation, pre-existing conditions and age limits.
By ExpatMedicare TeamReviewed by Damien FertéUpdated: 9 min read
Sources: insurer benefit tables, brochures and product documents, checked 28 Sept 2026
- Cigna GlobalInsurer: varies by where your policy is issuedCigna Global review →
- Bupa GlobalInsurer: varies by where your policy is issuedBupa Global review →
- Allianz CareInsurer: AWP Health & Life SAAllianz Care review →
- AXA Global HealthcareInsurer: varies by policy document issuedAXA Global Healthcare review →
International health insurance companies sell private medical cover to people living outside their home country, cover that moves with you. This page compares four of them on the same 17 published terms, read in each insurer's own documents on 28 September 2026. We do not rank them and we do not publish prices.
ExpatMedicare arranges international cover for expatriates.
In short
Cigna Global, Bupa Global, Allianz Care and AXA Global Healthcare sell 17 plan tiers between them, with overall annual limits from US$400,000 to unlimited. Cigna and Allianz sell a core hospital plan you add modules to. Bupa and AXA sell fixed tiers. Bupa, Allianz and AXA include medical evacuation on every tier, and Cigna sells it as a module on Silver, Gold and Platinum. Maternity waits run from 12 to 24 months. This is general information, not advice on your situation.
How do Cigna, Bupa, Allianz and AXA compare at a glance?
Five published terms, one row each. The full 17-point table follows.
| Term | Cigna Global | Bupa Global | Allianz Care | AXA Global Healthcare |
|---|---|---|---|---|
| Plan tiers | 4 | 5 | 3 | 5 |
| Plan style | Modular | Fixed tiers | Modular | Fixed tiers |
| Highest annual limit | Paid in full (Platinum) | Unlimited (Ultimate) | US$5,000,000 (Care Signature) | US$8,000,000 (Prestige Plus) |
| Medical evacuation | Optional module (Silver, Gold, Platinum) | Included | Included | Included, outside the overall limit |
| Maternity wait 1 | 12 or 24 months 2 | 18 months | 12 months | 18 months |
1 Maternity is on upper tiers only: Cigna Gold and Platinum, Bupa Elite and Ultimate, Allianz Care Enhanced and Care Signature, AXA Prestige and Prestige Plus. 2 12 months, or 24 months for treatment in the UK, Hong Kong or Singapore.
How do the four insurers compare on all 17 terms?
The same 17 rows, in the same order, appear in each of our two-insurer comparisons.
| Term | Cigna Global | Bupa Global | Allianz Care | AXA Global Healthcare |
|---|---|---|---|---|
| Insurer and regulator | Cigna Global Insurance Company Limited, Guernsey, regulated by the Guernsey Financial Services Commission. Singapore policies: Cigna Europe Insurance Company S.A.-N.V. Singapore Branch | Bupa Insurance Limited (UK), or Bupa Global DAC (Ireland) for EEA policies. Hong Kong plans are a separate product from Bupa (Asia) Limited | AWP Health & Life SA, Irish Branch, regulated by France's ACPR | AXA PPP healthcare Limited or AXA XL Insurance Company UK Limited (PRA and FCA), or AXA Insurance dac (Central Bank of Ireland), depending on the policy document issued |
| Plan tiers | 4: Close Care, Silver, Gold, Platinum | 5: Major Medical, Select, Premier, Elite, Ultimate | 3: Care Base, Care Enhanced, Care Signature | 5: Foundation, Standard, Comprehensive, Prestige, Prestige Plus |
| Overall annual limit | US$500,000 (Close Care) to paid in full (Platinum) | US$1,700,000 (Select) to unlimited (Ultimate) | US$1,350,000 (Care Base) to US$5,000,000 (Care Signature) | US$400,000 (Foundation) to US$8,000,000 (Prestige Plus) |
| How the plan is built | Core hospital plan plus up to four optional modules (Silver, Gold, Platinum). Close Care has built-in outpatient cover | Fixed tiers, outpatient built in from Select upwards | Core hospital plan plus optional outpatient and dental at the same tier | Fixed tiers, outpatient optional on Foundation and Standard and built in from Comprehensive upwards |
| Areas of cover | Worldwide including or excluding the USA. Close Care: your country of residence and nationality only | Worldwide, or worldwide excluding the US. Select, Premier and Elite also offer Europe | Worldwide, worldwide excluding the USA, Europe, or Africa | Worldwide, or worldwide excluding the USA |
| US treatment | Buy worldwide including the USA. Out-of-network US treatment is paid at 20% less | Blue Cross Blue Shield Association licensee. 28 days of emergency US cover on the excluding-US option | Buy worldwide. US access runs through a partner network on direct billing | Buy worldwide. On the excluding-USA option, emergency US treatment on every tier except Foundation |
| Hospital deductible options | US$0 to US$10,000, seven steps | Up to £5,000 (Select), £7,500 (Premier) or £10,000 (Elite). Major Medical options for UK and Channel Islands residents only. None on Ultimate | None, US$1,350, US$4,050 or US$8,100 | None, or US$160 to US$3,200 in five steps. Standard without outpatient also US$8,000 or US$16,000 |
| Outpatient | Optional module on Silver, Gold and Platinum. Close Care: built-in, US$5,000 | Not on Major Medical. £7,500 (Select) to unlimited (Ultimate) | Optional add-on. £8,300 (Care Base) to no limit (Care Signature) | Optional on Foundation and Standard. Built in from Comprehensive (US$5,600) upwards |
| Maternity and waiting period | Gold and Platinum. 12 months, or 24 months for treatment in the UK, Hong Kong or Singapore | Elite and Ultimate. 18 months | Care Enhanced and Care Signature. 12 months | Prestige and Prestige Plus. 18 months |
| Dental | Optional module. Waits of 3 months (routine), 12 months (major), 18 months (orthodontic) | Premier, Elite and Ultimate. 6-month wait. Orthodontics on Elite (£2,500) and Ultimate (£10,000) after 12 months | Optional add-on. 10-month wait for orthodontics and prostheses | Non-routine dental from Standard upwards. Routine dental an upgrade, built into Prestige Plus. Waits not published |
| Medical evacuation | Optional module (Silver, Gold, Platinum). Close Care: road ambulance only | Included on every tier | Included on every tier | Included on every tier, outside the overall limit |
| Pre-existing conditions | Medical questionnaire. Exclusions, or cover at extra premium. No moratorium published | Excluded unless a medical loading is agreed. Individual applications fully medically underwritten. No moratorium published | Full medical underwriting, a 24-month moratorium, or your previous insurer's terms carried over | Full medical underwriting, a moratorium, or your previous insurer's exclusions carried over |
| Direct billing and claims | Direct payment where possible. Aims to confirm payment within 1 hour and pay claims within 5 working days | Cashless settlement for hospital treatment at network facilities | Direct settlement for most inpatient treatment. Claims by app or portal | Pays providers directly in many cases. Says 83.2% of eligible online claims in 2025 were paid within two days |
| Maximum age to join | No upper age limit | No upper age limit on plans issued by Bupa Insurance Limited (target market statement, May 2026). Not published for other Bupa insurers | Day before 76th birthday (full medical underwriting). Day before 65th (moratorium) | Under 80 for moratorium or switch terms. 80 and over on full medical underwriting or a plan transfer, with some exclusions |
| Renewal | Renews automatically. Premiums not based on your claims history | Renews automatically. No cancellation because of your claims history | Renews automatically. No new personal exclusions at renewal for conditions that start after you join, if you disclosed as asked and have not applied to increase cover | Claims do not raise your renewal premium. Inflation and age still can |
| Cooling-off | 14 days (Guernsey-issued policies), 3-month minimum term | Ultimate: full refund within 30 days if no claims, otherwise 14 days' notice. Other tiers not published | 30 days, then fixed until renewal | 14 days from receiving your membership pack |
| Paying monthly | Annual or quarterly "slightly lower". No figure published | Not published | 5% monthly, 4% quarterly, 3% half-yearly, 0% annual | Paying annually saves 5% |
Figures are the insurers' own, checked on 28 September 2026: Cigna's benefit table for policies starting or renewing from 15 February 2026, Bupa's UK and Channel Islands brochure (April 2026), Allianz's benefit table valid from 1 November 2025, and AXA's individual brochure (April 2026) and benefits summary (October 2025). Terms can differ by the country your policy is issued from. Your certificate of insurance is the document that binds. Bupa's entry age comes from its target market statement for plans issued by Bupa Insurance Limited (May 2026), and its Ultimate cancellation terms from the Ultimate membership guide (October 2026 edition), both read on 29 September 2026.
How are the plans built?
International health insurance plans are built in one of two ways.
- Modular (Cigna Global, Allianz Care): you buy hospital cover, then add outpatient, dental and, on Cigna, evacuation.
- Fixed tiers (Bupa Global, AXA Global Healthcare): each tier carries a set list of benefits. Outpatient is built in from Bupa's Select and AXA's Comprehensive upwards.
Cigna's modules are sold on Silver, Gold and Platinum. Its Close Care plan takes no modules and builds in outpatient cover up to US$5,000 a year.
A modular quote can leave out evacuation. Read it line by line against the table.
How do maternity waits and evacuation compare?
Maternity wait: Allianz Care 12 months. Bupa Global and AXA Global Healthcare 18 months. Cigna Global 12 months, or 24 for treatment in the UK, Hong Kong or Singapore, and its optional benefits page says the wait "may be 12 or 24 months depending on your insurance entity". All four put routine maternity on upper tiers only, and the wait runs from the day cover starts. See our maternity and family cover guide.
Medical evacuation: included on every tier at Bupa Global, Allianz Care and AXA Global Healthcare. Cigna Global sells it as an optional module, International Medical Evacuation, on Silver, Gold and Platinum. Its Close Care plan covers road ambulance only. AXA's plans page states that evacuation is not taken out of the overall benefit allowance. On AXA's Foundation tier, that allowance is US$400,000.
How are pre-existing conditions and age at entry handled?
Both can decide whether you are accepted at all, before any benefit limit applies.
- Cigna Global: medical questionnaire, then an exclusion or cover at extra premium. No moratorium published. Cigna publishes no upper age limit to join.
- Bupa Global: excluded unless an agreed medical loading covers them. Individual applications are fully medically underwritten, and Bupa publishes no moratorium. Bupa's target market statement (May 2026) says "There is no upper age limit" on plans issued by Bupa Insurance Limited. Bupa does not publish an entry age for its other insurers.
- Allianz Care: publishes three routes: full medical underwriting, a 24-month moratorium, or your previous insurer's terms carried over. Joining age: up to the day before your 76th birthday on full medical underwriting, the day before your 65th on moratorium.
- AXA Global Healthcare: full medical underwriting, your previous insurer's exclusions, or a moratorium that excludes conditions from the five years before you join until you have been a member for two years and trouble-free from that condition for two. Moratorium and switch terms need you to be under 80, according to AXA's retiree cover page. From 80, full medical underwriting or a plan transfer, with some exclusions.
Disclose honestly. A non-disclosure found at claim time can void the policy.
Which insurers are compared here?
We chose these four because each publishes enough of its own documents to fill all 17 rows, with gaps marked where it does not.
- Cigna Global: part of The Cigna Group, which reports its international health business inside Cigna Healthcare in its second-quarter 2026 filing.
- Bupa Global: the international health insurance division of Bupa, and an independent licensee of the Blue Cross Blue Shield Association in the United States.
- Allianz Care: the brand of AWP Health & Life SA, which also trades as Allianz Partners.
- AXA Global Healthcare: AXA's international health business. AXA Group said in April 2025 that it serves 95 million clients in 50 countries.
Read each insurer's full review: Cigna Global, Bupa Global, Allianz Care and AXA Global Healthcare.
Other insurers you will see
- William Russell: sells health, life and income protection cover to expats. Its European business is a mandated underwriter for AWP Health & Life SA, the insurer behind Allianz Care.
- Now Health International: acts on behalf of insurers in some markets and provides administration and technology services in others, so check the insurer named on your policy.
- Blue Cross Blue Shield Global Solutions: GeoBlue's name since September 2025.
- Aetna International: stopped offering most new individual policies and renewals in Europe, the Middle East, Africa and Asia-Pacific from 1 November 2022, according to Aetna International.
Which insurer comparisons can you read?
Each comparison sets two insurers side by side on the same 17 rows as the table above.
| Term | Cigna Global | Bupa Global | Allianz Care | AXA Global Healthcare |
|---|---|---|---|---|
| Cigna Global | Cigna vs Bupa | Cigna vs Allianz | AXA vs Cigna | |
| Bupa Global | Cigna vs Bupa | Bupa vs Allianz | AXA vs Bupa | |
| Allianz Care | Cigna vs Allianz | Bupa vs Allianz | AXA vs Allianz | |
| AXA Global Healthcare | AXA vs Cigna | AXA vs Bupa | AXA vs Allianz |
Living in Singapore? Our best international health insurance in Singapore looks at international and local options together. Country guides: Singapore, Hong Kong, Thailand and Dubai.
How should you compare international health insurance?
Compare on the terms that decide a claim, then on price:
- Overall annual limit: the most the insurer pays in a year.
- Deductible: what you pay first, and which claims it applies to.
- Area of cover: and what emergency US cover an excluding-USA option keeps.
- Underwriting: full medical underwriting settles exclusions on day one. A moratorium decides at claim time.
- Maternity wait: it has to start before a pregnancy.
- Evacuation: included, a module, or missing from your quote.
- Direct billing: which named hospitals near you the insurer settles with directly.
- Renewal terms: whether claims can raise your premium or change your terms.
Premiums depend on your age, area of cover, deductible, tier and medical history, so we publish no prices here. Our expat health insurance cost guide explains what moves a premium.
Which company insures you?
The company that insures you is the legal entity named on your policy documents, and it is often not the brand. It decides which regulator oversees the contract and where a complaint goes. Row 1 of the full comparison names each one.
Cigna's Singapore policies are written by a different Cigna company from its Guernsey policies. AXA Global Healthcare uses three insurers, each with its own product information document (see the AXA XL, AXA PPP and AXA Insurance dac versions of the Standard plan). Ask which one applies to your quote.
How we compared the insurers
- Insurer documents only: every figure comes from the insurer's own plan pages, brochures, benefit tables or product information documents, read on 28 September 2026.
- One table everywhere: this page and every two-insurer comparison use the same 17 rows, so they agree.
- Gaps stay gaps: where an insurer does not publish a term, the table says so.
- No prices, no ranking: no insurer is scored or placed first.
Frequently asked questions
Is one international health insurance company right for everyone?
No. The four compared here publish different terms. Cigna Global publishes no upper age limit to join and sells evacuation as an optional module on Silver, Gold and Platinum. Bupa Global, Allianz Care and AXA Global Healthcare include evacuation on every tier. Allianz Care publishes a 24-month moratorium for pre-existing conditions. Which terms matter depends on where you live, your age, your medical history and whether you plan a pregnancy.
Who underwrites AXA Global Healthcare plans?
AXA Global Healthcare plans are insured by AXA PPP healthcare Limited or AXA XL Insurance Company UK Limited in the UK, or by AXA Insurance dac in Ireland, depending on the policy document issued. Each insurer has its own product information document, so ask which one applies to your quote.
Which international health insurers include medical evacuation?
Bupa Global, Allianz Care and AXA Global Healthcare include medical evacuation on every tier. Cigna Global sells it as an optional module, International Medical Evacuation, on Silver, Gold and Platinum, so check that it is on your quote. Cigna's Close Care plan covers road ambulance only.
How long is the maternity waiting period on international health insurance?
At the four insurers compared here it runs from 12 to 24 months. Cigna Global waits 12 months, or 24 for treatment in the UK, Hong Kong or Singapore. Bupa Global and AXA Global Healthcare wait 18 months. Allianz Care waits 12 months. All four cover routine maternity only on their upper tiers.
Can I join an international health insurer over 65?
Yes, at some insurers. Cigna Global publishes no upper age limit. Allianz Care accepts full medical underwriting up to the day before your 76th birthday, and moratorium up to the day before your 65th. AXA Global Healthcare accepts moratorium and switch terms under 80, and full medical underwriting or a plan transfer from 80, with some exclusions. Bupa Global states there is no upper age limit on plans issued by Bupa Insurance Limited, and does not publish one for its other insurers.
Is Aetna International still selling expat health insurance?
Not for most expats. Aetna International stopped offering most new individual policies and renewals in Europe, the Middle East, Africa and Asia-Pacific from 1 November 2022, and moved those customers to Allianz Partners by 31 October 2023. Its Americas business is now part of Aetna, a CVS Health company, and focuses on US expatriates.
Sources
- 01Cigna Global, plans in detail (benefits from 15 February 2026), optional benefits and seniors page
- 02Cigna Global Health Options sales brochure, February 2026
- 03The Cigna Group, Form 10-Q for the quarter ended 30 June 2026
- 04Bupa Global, plan comparison (Guernsey), sales brochure April 2026 and legal notices
- 05Private Client by Bupa, Ultimate plan benefits and Ultimate membership guide (October 2026 edition); Bupa Insurance Limited, target market statements (May 2026); Bupa Global individual application forms, UK and Channel Islands and EEA
- 06Allianz Care, international healthcare plans, Individual Benefit Guide (valid from 1 November 2025) and regulatory information
- 07AXA Global Healthcare, international health insurance plans, pregnancy and maternity and retiree cover
- 08AXA Global Healthcare, individual sales brochure April 2026 and individual summary of benefits October 2025
- 09AXA Global Healthcare, Standard insurance product information documents (three insurers, linked above) and legal information
- 10William Russell, Now Health International, Blue Cross Blue Shield Global Solutions and Aetna International, own websites and releases (linked above)
This page is general information about insurance products, not personal financial advice. Benefit limits, waiting periods, underwriting terms and exclusions vary by plan, by the country your policy is issued from and by your own underwriting. The terms that apply to you are those in your certificate of insurance and policy documents. Figures are as published by each insurer and were checked on 28 September 2026. Speak to a licensed adviser about your circumstances before buying.