White paper by Seeta Hammer, Senior Clinical Director, Aetna International

Pre and post assignment coordination improves expatriates experiences abroad

When U.S. citizen McKenzie was assigned a short-term overseas trip to the Philippines, he worried about managing his sleep apnea far from home. Diagnosed later in life, McKenzie relied on continuous positive airway pressure (CPAP) treatment to stay productive during long workdays without suffering from low energy or lack of mental clarity. Transporting the medical device and securing replacement parts would prove difficult. Going without treatment could drastically impact his work performance.

By contacting his health benefits provider’s medical services team for comprehensive pre and post assignment coordination, McKenzie also set important preparations in motion. As well as gaining a thorough understanding of his overall health and well-being, and providing pertinent advice about his host country, his clinical manager coordinated rental of a compatible CPAP machine equipped with McKenzie’s prescribed settings. Additionally, they negotiated McKenzie’s in-network treatment rates to minimize out-of-pocket fees.

Ongoing communication after his arrival kept tabs on the arrangements’ effectiveness. In McKenzie’s own words, “Thank you for helping me get the CPAP machine. It has helped me sleep better and feel less tired during long workdays.”

The advanced coordination provided by the pre and post assignment coordination team gave McKenzie the ability to excel professionally without health hindrances.

Unfortunately, awareness of pre and post assignment coordination and its on-going benefits among organizations, international human relations managers and employees is relatively low.  For expat assignees or business travelers managing medical conditions, lack of planning can quickly jeopardize overseas productivity and well-being. But comprehensive pre-assignment preparation empowers effectiveness no matter the destination. pre and post assignment coordination is just the tip of the clinical capabilities’ iceberg.

Tip of the iceberg

Realizing ambitions: Supporting global travelers and corporate strategies

The winds of change are gathering force in the world of international business. The rise of global business has led organizations to increasingly utilize flexible global work arrangements (FGWAs) — encompassing business travelers, flexpatriates, short-term assignees, commuters, and rotational workers — enabling strategic agility¹. As traditional expatriation is complemented by these agile forms of global mobility, the significance of understanding the complex needs of the individual and their families appropriate to their unique scenario is increasingly important. It is paramount that tailoring health, well-being and work-life support is started via pre and post assignment coordination support and then continued throughout the business travel or expat assignment lifecycle.

Spending on global business travel alone is estimated to reach $1.8 trillion by 2027². Qualitative interviews reveal that frequent travel plays a dual role for employees — acting as both a demand and a resource and impacting their well-being, both negatively and positively³. It is also important to note that as business trips and flexible assignments rise amid rapidly shifting work contexts, effectively balancing responsibilities across life spheres – professional (career transition concerns, perceptual barriers) and personal (stress, identity transformation) – is crucial.

Amidst this complex landscape, international human resources’ traditional role in managing conventional expatriates is notably absent for FGWAs. At Aetna International, we propose transforming pre and post assignment coordination, often viewed as a static clinical and logistical process focused narrowly on the pre-assignment phase of the expat assignment lifecycle, into a gateway for continuous, holistic health, wellness and work-life support throughout the global worker’s journey.

Rather than approaching work and personal life as competing priorities, this new paradigm envisions them as complementary elements reinforced through robust and empathetic pre-assignment planning preparation and on-going support. Such multifaceted assistance can foster smooth transitions for global workers and families alike — from home country to host location, and back again.

Evolving in line with emerging global mobility challenges

Global workforce trends are reshaping the support that multinational organizations and international human resources representatives provide to their global workforce.

1. Mental health following a trauma or crisis

Traumatic events since 2020 have led assignees and travellers to prioritize mental well-being, requiring robust employer resources⁴. Various experts also suggest that there is also a growing need to destigmatize mental health declarations, self-help services, professional care and insurance claims to make a real difference in this space. Post-traumatic growth through self-reflection and relationship building may offer individuals and companies meaningful ways to process trauma⁴.

2. Remote work realities

The pandemic accelerated demand for remote and hybrid work globally⁵. Employees increasingly expect location flexibility, pushing boundaries on formal global assignment policies. Organizations must provide accessible tools for autonomous support across domains like healthcare and work-life balance. This transforming landscape requires thoughtful evolution in expatriate support strategies. As assignee priorities and needs change, so must employer offerings across the assignment lifecycle. The time is now to reimagine pre and post assignment coordination as a gateway to continuous, holistic care.

The blueprint for assignment evolution

Holistic health care for the whole family

Embarking on a paradigm-shifting journey in expat assignments requires that organizations embrace a holistic health care approach for assignees and their families. The blueprint for this evolution commences with a reimagined standard in expat assignments—one that centers on the individual and their family, fostering a holistic and personalized approach to pre and post assignment coordination.

Up to 80 hours of clinical support

As per the latest Aetna International data, pre-assignment planning during the pre-assignment phase typically involves anywhere from 16 to 80 hours of clinical support . However, the clinical manager then remains at the assignee's side throughout the entire duration of the assignment, ensuring continuous assistance tailored to the needs of the individual and their immediate family. This holistic journey goes beyond conventional norms, offering a nuanced and interconnected web of services designed to enhance health, wellness, and work-life support. It is during pre and post assignment coordination that the foundations for managing work and personal life priorities are established, providing a seamless experience throughout the assignment lifecycle.

This multifaceted assistance not only facilitates smooth transitions for global workers and families but also lays the groundwork for sustained well-being and success in their entire expat journey.

Interconnected care: A holistic view of the expat assignment lifecycle 

Phase 1: Pre-assignment excellence

Embarking on a paradigm-shifting journey in expat assignments requires that organizations embrace a holistic health care approach for assignees and their families. The blueprint for this evolution commences with a reimagined standard in expat assignments—one that centers on the individual and their family, fostering a holistic and personalized approach to pre and post assignment coordination.

In the dynamic expat journey, the pre-assignment phase is a pivotal cornerstone. It marks a point at which organizations and employees can lay the foundations for holistic support regardless of what lies ahead.

During this critical phase, a team of highly skilled registered nurses and clinicians assumes a central role. Their expertise extends beyond the immediate concerns of the business traveler or assignee; instead, they build a comprehensive picture of the health and needs of the entire family. This approach allows them to tailor bespoke recommendations and provide ongoing direction and guidance, navigating vital care pathways throughout the entire duration of the assignment or trip.

Importantly, regardless of how appropriate, qualified, or essential the organization deems the assignee or business traveler to be to their strategy, there exist hidden health and well-being factors that may elude awareness. This is precisely where the discretion and support of a PTP clinician becomes invaluable, adeptly removing potential obstacles for the individual or their family. It is this proactive and personalized care that fortifies the foundation of a successful and well-supported expat journey.

At Aetna International, we aim to address member inquiries within 2 business days or less, offering insights into service intensity and coordination with providers, including third party administrators¹³. We receive requests that range from simple queries about Autism Spectrum Disorder treatment providers to complex scenarios like sourcing temperature-controlled medications, necessitating careful logistical coordination.

Phases 2 to 4: Navigating the expatriate odyssey

As the expatriate journey unfolds, Phases 2, 3 and 4 encapsulate a dynamic progression from the initial "Honeymoon" phase through the inevitable "Culture Shock" and ultimately towards seamless "Integration." Each phase introduces unique challenges and opportunities, shaping the assignee's and their family's experience in profound ways. 

The dedicated clinical nurse assigned to the individual's care is more than a provider of medical assistance—it's a continuous source of health care and well-being navigation support. Beyond addressing medical needs, this nurse can also serve as a troubleshooter, adeptly resolving any challenges encountered by the employee or their family members.

In order to offer genuine support, it’s critical to go beyond the passive provision of resources. Instead, a concierge-style approach is required, tailoring assistance to the unique circumstances that individuals face. For instance, if an employee expresses difficulty navigating the nuances of their new workplace culture, the concierge-style recommendation might be the Manager Assist service. This proactive and personalized method is indispensable in helping employees and their families overcome both personal and professional challenges that inevitably emerge during various phases of the expat assignment or business trip lifecycle. It's not just about providing tools; it's about offering a helping hand uniquely suited to each situation, ensuring a smoother and more supported journey.

During the pivotal phases 2, 3, and 4 of the expat assignment or business trip lifecycle, we advocate for guidance and provision that is precisely tuned to the pressing personal and professional challenges faced by employees and their families. As a minimum, this tailored support framework includes:

Cultural awareness in health care: Clinical support infused with cultural competence fosters adaptation and facilitates smoother navigation of health care.

Targeted well-being offerings: Comprehensive virtual and in-person wellness programs are designed to tackle stress management, change adaptation, and emerging mental health needs during transitions.

Specialized workplace support: From life coaching to manager assist and work-life balance support, organizations can shape their employees' professional experiences in alignment with contemporary expectations, thereby bolstering talent attraction and retention strategies.

Local care continuity: Proactive assistance in locating reputable local providers, facilities, and equipment ensures seamless continuity in care. Effective care coordination is pivotal.

Medical care and prescription management: Coordinating routine and urgent care, prescription transfers, and referrals safeguards against gaps in health care during relocation.

Insurance and health care navigation: Guiding individuals through host country health systems, insurance rules, and regulations leverages global expertise for a smoother health care journey.

Specialized condition management: Access to specialized care through expansive provider networks and advanced technologies supports ongoing health maintenance.

24/7 emergency access: Offering around-the-clock telemedicine and emergency assistance considers local regulations for seamless support.

Ongoing risk mitigation: Providing location-specific health insights on risks, diseases, vaccines, and more enables proactive vigilance, ensuring a comprehensive approach to well-being throughout the assignment or trip.

Phases 5: Closing the loop on the return journey

With the surge in remote and alternative assignments, companies must transition from a singular focus on initial preparations to providing continuous, holistic support spanning the entire expatriate lifecycle. A key facet often overlooked but crucial to this support framework is the repatriation stage.

The evolving expatriate profile, characterized by an increasing number of families on the move, amplifies the complexity of returning home. Recognizing this, comprehensive assistance during the repatriation transition becomes indispensable. Here's how it contributes to a seamless journey back home:

Ease logistics: Consultative planning for coordinating care, and managing devices and medications ensures a smooth landing, easing the logistical challenges of returning.

Foster reintegration: Cross-cultural and emotional support plays a pivotal role in aiding families to readjust personally and professionally to life back home, fostering a smoother reintegration.

Sustain health: Providing guidance on both physical and mental health helps mitigate common stresses, such as reverse culture shock, ensuring sustained well-being during this period of massive change.

Specialized workplace support: Offering support, ranging from life coaching to manager assist and work-life balance, enables organizations to actively shape their employees' professional experiences in alignment with contemporary expectations. This, in turn, fortifies talent attraction and retention strategies.

The philosophy that guides pre-assignment and post assignment coordination should extend seamlessly into the post-assignment phase. By compassionately guiding families back home, companies complete the circle of care initiated when global journeys began, upholding duty of care from start to finish.

This retention strategy not only allows organizations to maximize their investment in talent mobility but also empowers global employees to integrate assignments into long-term personal and professional growth. As we contemplate lessons from repatriation support, the synergy across stages becomes a crucial consideration for modern employers aiming to holistically weave well-being throughout contemporary global careers.

Health benefits providers and employers must streamline the point of entry for holistic and comprehensive support for their employees. It begins with a straightforward action—whether by dialling the number on their ID card to connect with the pre and post assignment coordination team, sending a direct email, or contacting their international human resources team. This simple step is the critical opener, granting access to holistic care across the expat assignment lifecycle or business trip.

Seizing competitive advantage

Evolving to meet the needs of a changing global workforce

In a world where pre-assignment planning support has often been relegated to a clinical checklist, an inventory of vaccinations and screenings, the question arises: Can such a limited approach truly set employees and their families up for success in today's intricate global landscape?

This white paper serves as a call to action, urging employers to revolutionize their perspective and construct robust systems that champion continuous holistic health and well-being—from pre and post assignment coordination preparations to repatriation. Herein lies an exceptional opportunity to redefine duty of care as a fundamental competitive edge.

By embracing personalized offerings encompassing health and well-being access, remote work resources, and phase-specific transition assistance, organizations can empower their talent to not just navigate but thrive on assignments.

Moreover, a modern global support model acknowledges the inseparable link between employee experience and family well-being, resonating with the changing dynamics of flexible global work arrangements. When an organization genuinely cultivates a sense of community and work-life synergy for global talent, the collective ascends together.

As we face the horizon ahead, shaped by evolving global mobility trends, the imperative is clear: invest in holistic growth across the expatriate ecosystem. For those bold enough to lead this necessary evolution, the rewards are substantial—an enhanced quality of life for your global families, strengthened retention in an era of worker leverage, and elevated employer brand equity. The question now is, shall we embark on this transformative journey together?

About us

About Aetna International

When it comes to the expertise and innovation of Aetna International, our focus begins with the health care benefits plans we offer and the flexibility they provide. We have a wide range of plan designs available that can meet your company's needs. Furthermore, our international expertise allows us to address unique challenges that may not be covered by traditional health plans. We have experience in various verticals, including faith-based organizations, inpats with specific care expectations, and government organizations with special requirements. We also specialize in serving groups facing population health challenges. In line with our commitment to simplifying the international health care experience, we have recently enhanced our fully insured plans. Care received outside of the U.S. is now covered at 100%, with no deductible and no coinsurance. With our comprehensive solutions, we are dedicated to meeting your organization's unique needs and ensuring peace of mind for both companies and employees⁸.

About Seeta Hammer

Seeta has over 25 years of clinical experience in the health care industry. She has a broad background as a registered nurse specializing in critical care nursing. Seeta has been with Aetna since 2002 and is a Board-Certified Case Manager and Registered Nurse. In her current role, Seeta manages a culturally diverse team of Clinical Managers and Supervisors. Together, she and her team are responsible for coordinating the medical and psychological services for members both stateside and abroad for the Americas book of business. Seeta remains a passionate advocate and clinical educator for her members and customers. Her mission is to help her members navigate the complex global healthcare systems and access care based on their individual healthcare needs and goals. Seeta volunteers her time by serving the homeless in her community. Seeta is a member of the Commission for Case Manager (CCMC) Organization and the Case Manager Society of America (CMSA).