Allianz, AXA, Bupa, Cigna. They are not always the best value, and on any given benefit one of them will be beaten by a smaller specialist. But international health insurance is one of the few products you buy at 35 and need at 70 — and over that horizon, who is still standing matters more than who was cheapest in year one.
That instinct is right. It is also incomplete, and the incomplete part is where people get hurt.
Where the Big Four stand
Capital strength on the listed groups is publicly reported and substantial. Allianz reported a Solvency II ratio of 221% in Q1 2026, up from 218% at full-year 2025, and carries a Moody's Aa2 insurance financial strength rating. AXA reported a Solvency II ratio of 224% at end-2025, with shareholders' equity of €47.2bn.
Bupa's structure is different in a way worth understanding: it has no shareholders, which means profits are reinvested rather than distributed. Bupa Global is a trading name of Bupa Insurance Limited and Bupa Insurance Services Limited, authorised by the PRA and regulated by the FCA and PRA.
Cigna's international business sits across several entities, including Cigna Global Insurance Company Limited in Guernsey and Cigna Europe Insurance Company S.A.-N.V., whose Singapore branch underwrites Singapore policies.
All four are, on any reasonable reading, going to be around. That is genuinely a reason to prefer them, and I would not argue otherwise.
But solvency is not your real risk
Regulated insurers in these markets very rarely fail. Solvency II exists precisely to make failure remote, and policyholder protection schemes catch the residual — Cigna's Singapore policies, for instance, are covered automatically under the Policy Owners' Protection Scheme administered by SDIC, with no action required from the policyholder.
The risk that actually destroys expat policyholders over a thirty-year horizon is different, and no solvency ratio predicts it:
“The insurer stays solvent and closes your book.”
An insurer decides a market or product line is no longer strategic. It stops writing new business but keeps servicing existing policies. What happens next is mechanical: healthy members shop around and leave, because they can. Members who have developed conditions cannot leave, because they would be re-underwritten. The remaining pool gets sicker, claims rise, premiums rise, more healthy members leave. The spiral runs for years.
You are not uninsured. You are trapped in a shrinking pool paying escalating premiums for a product no longer sold to anyone new — and by then, your medical history is the reason you cannot move.
This has happened repeatedly in international health. It is the single largest long-horizon risk in the product, and scale reduces it only partially. Large groups exit markets too — often more decisively than small ones, because they have portfolio discipline and shareholders.
The question the balance sheet doesn't answer
So yes, buy scale. But interrogate it properly:
- Which entity is on my certificate of insurance? You are not insured by "Cigna" or "Bupa" the group. You are insured by a specific licensed entity in a specific jurisdiction. Get the name. That entity's capital, regulator and protection scheme are what apply to you — not the group's headline solvency ratio.
- Is my policy underwritten inside or outside the jurisdiction where I live? This determines which protection scheme, if any, covers you. Bupa's own literature notes the FCA does not regulate Bupa Insurance Limited activities taking place outside the UK.
- Is this product actively sold to new members in my market today? A product still open to new business is a product the insurer intends to keep. A quiet closure is the early warning.
- What is the guaranteed renewability position? Can the insurer decline to renew me individually, or only withdraw the product for everyone? The difference is everything at 68 with a cardiac history.
- What has this specific plan's premium done over the last five years in my market? Not the group's growth. The book you would be joining.
The honest conclusion
Scale is a rational tiebreaker, and among broadly comparable plans I would take the stronger balance sheet every time. But it is a tiebreaker, not a strategy.
What protects you over thirty years is a large insurer that still writes your product in your market, on terms it cannot withdraw from you individually. The balance sheet keeps the company alive. The book keeps you insurable. They are not the same thing, and only one of them is printed in the annual report.
“Ask Mira which entity underwrites your plan, and whether your book is still open — before your medical history makes moving impossible.”
Written and verified by Jean-Marc Herbet — Managing Director, Expat Medicare. Thirty years advising expatriates on international private medical insurance across Asia. Expat Medicare is a licensed IPMI brokerage. General information, not personal, financial or investment advice. Solvency ratios and ratings cited are as reported by the relevant groups and rating agencies at the dates stated and change over time; verify current figures before relying on them. Underwriting entities, regulators and policyholder protection arrangements vary by market and product. Refer to the policy documents issued with your quotation.
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