Two French groups dominate international health cover for francophone expatriates. Between them they represent well over €1 billion in group turnover. And they arrived at the same market from opposite directions — which is the single most useful thing to understand before choosing.
Two different companies wearing the same jacket
MSH was born corporate. Founded in 1974 to insure the globally mobile employees of large French businesses through dedicated group solutions, it grew inside a brokerage house rather than an insurer. Today it sits within the Diot-Siaci Group — around €905m turnover in 2023, 6,000 staff, ranked first in France for group health and life — with MSH itself carrying roughly 500,000 members across 200 countries and 2,000 corporate clients. Its instincts are CAC 40 instincts: duty of care, delegated management, mobility teams, HR directors.
April was born retail. Created in Lyon in 1988 by Bruno Rousset, listed in 1997, it became the French wholesale broking champion — a brand every French household recognises, distributing through some 20,000 independent brokers and direct. It was taken private by CVC in 2019 and sold to KKR in 2022 at a valuation near €2.3–2.4bn, roughly fifteen times EBITDA, alongside Evolem, Crédit Mutuel Arkéa, Téthys Invest and Burrus. Its instincts are distribution instincts: product design, digital journey, price points, conversion.
Neither of them is, in the ordinary sense, your insurer.
The thing nobody tells you: check who actually carries the risk
Both companies design and manage plans; underwriting capacity sits with partner carriers behind them. MSH builds its plans with insurance and assistance partners — Europ Assistance handles pre-authorisation and evacuation, and it is Europ Assistance you call first for a letter of guarantee that makes direct billing work. April likewise designs and distributes, with risk carried by partner insurers.
This matters for three practical reasons:
- Your claim is paid by a company whose name is not on your card. Know which one, and where it is regulated.
- Carrier arrangements change. A renewal can bring new terms that originate with the risk carrier rather than the brand you bought from.
- The service you're actually buying is the management layer — pre-authorisation speed, direct billing reach, claims turnaround. That is where these two genuinely differ, and it is invisible in a benefits table.
Ask for the underwriting entity in writing before you sign. Neither company hides it; almost nobody asks.
Ownership shapes what happens at renewal
MSH's parent is majority-held by the Burrus Group and management, with Ontario Teachers' Pension Plan, Bpifrance and others alongside — long-horizon, institutional, partly state-adjacent capital.
April is held by KKR on a stated eight-to-ten year investment horizon, acquired with leverage at a full multiple, with an explicit mandate to accelerate growth, digitalisation and acquisitions in IPMI.
Neither structure is better. But they create different pressures, and a policy you intend to hold for twenty years is a bet on how the owner behaves in year eight. If you are buying long-term cover, ask both about renewal pricing history on your specific plan over the last five years — not the headline premium. That question separates the two far better than any brochure.
Where each one tends to win
MSH fits you if you are covered through an employer scheme or arrived via one, you are with an international organisation or NGO, you value a single mobility-grade service layer across many countries, or you are in Asia and want the Europ Assistance evacuation and pre-authorisation channel. Its Asia claims operation is centred in Shanghai. Its DNA is managing complexity for populations, and that shows.
April fits you if you are an individual or family buying direct, you want a modular plan you can tune, and you want the strongest digital experience. MyHealth International is genuinely modular: five levels of cover, inpatient mandatory, with outpatient, dental and vision, and maternity as separate choices — and, critically for French expats, a choice between cover from the first euro or as a top-up to CFE. Maternity carries a 12-month waiting period.
One April detail that matters directly in Asia: on certain plan levels, the reduced coverage ceiling applies specifically to the USA, Bahamas, Puerto Rico, Japan and Singapore, with cover unlimited elsewhere. If you live in Singapore, that is not a footnote — it is the plan's most important line. Verify which level you are being quoted.
The CFE question underneath all of this
Both are CFE partners, and for most French expats the real decision is not "MSH or April" but "CFE plus a top-up, or full first-euro international cover". That choice changes the answer entirely — a top-up plan and a first-euro plan are not comparable products even from the same insurer, and the cheaper monthly figure usually belongs to the one that leaves you exposed.
April lets you choose either construction inside the same product family. MSH's strength is more pronounced on the corporate and delegated-management side. Decide the CFE question first; the insurer question resolves itself much faster afterwards.
The verdict
MSH for employer-linked, NGO and internationally-mobile populations, and anyone who values the mobility service layer above product flexibility.
April for individuals and families buying direct who want modular control, the CFE top-up option and the better digital journey.
For either, verify three things on your quotation: the underwriting entity carrying the risk, whether you are being quoted first-euro or CFE top-up, and the country-specific coverage ceilings applying to your city of residence.
“Ask Mira to compare MSH and April for your age, country and CFE status — real 2026 premiums, at matched construction.”
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 advice. Group turnover figures refer to the parent groups and not to international health insurance activity alone. Plan structures, limits and waiting periods vary by product version, market and policy year. Refer to the Table of Benefits and General Conditions issued with your quotation.
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