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The Expert Guide to Health Insurance for Remote Workers

health insurance for remote workers

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Key Takeaways

1. Remote working is here to stay and businesses need to rethink the benefits packages they provide to remote employees and other remote workers. 

2. In some countries, employers are legally obliged to provide health insurance for employees (remote or otherwise), although usually not for contractors. Companies may also choose to offer a competitive health insurance package to workers in order to hire and keep the best talent.

3. There are a number of health insurance options which companies can choose for their remote workforce. Health insurance and other benefits may be administered directly or outsourced to a third party organization

4. Businesses need to consider the full spectrum of opportunities, challenges and risks around health insurance for remote workers, including rules and requirements in particular countries where their overseas workers are based.

As remote working becomes increasingly normalized, businesses are having to rethink their traditional approach to worker benefits including health insurance. In 2022, international business and HR leaders must meet the challenge of offering a modern and competitive benefits package which attracts remote workers, while ensuring compliance with all local legal and tax requirements. 

When putting together a company remote working policy, you will need to factor in what health insurance is needed for your workforce, and how best to provide it. Worker location can have a major effect on cost, coverage and application of health insurance benefits, especially where remote workers are based overseas. Our article takes you through some of the key considerations and questions.

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Is remote workers health insurance necessary?

Whether health insurance is a necessary benefit for your remote workers will vary widely from country to country, and potentially according to the nationality and/or residency status of the worker.

For the purposes of long-term business strategy, you should also consider what “necessary” means for your company. Even where provision of health insurance is not legally required, it may be a major key for attracting top talent. In the era of “the great resignation”, boosting your appeal as an employer could be more important to long-term business success than any short-term cost cutting on non-mandatory staff benefits.

In countries where there is a universal public health service for residents, health insurance may be less necessary. However, the public health service might also be lower quality or very slow, meaning that health insurance is expected even though it’s not strictly necessary. Where there isn’t any public health service, health insurance is likely to be a necessity for all workers.

We can illustrate the variety of cases by looking at the health insurance picture for workers based in some key countries or situations:

  • USA
  • There is no universal public healthcare system in the USA and health insurance can be very expensive for individuals. While smaller employers are not legally obliged to provide health insurance nor paid sick leave, in practice many companies use a good health insurance package to attract and retain a talented workforce. Under the Affordable Care Act (ACA), larger employers with 50+ full-time equivalent employees (NB not contractors) must offer health insurance.
  • United Kingdom
  • The UK’s National Health Service (NHS) is funded by a National Insurance contribution scheme via the tax system and free to residents at the point of access. Few UK citizens (around 10.5%) choose to take out health insurance compared to other European countries. There may still sometimes be advantages to private healthcare access, especially in terms of reduced waiting times or quick access to a particular facility. A similar system (funded by payroll taxes) applies under French labor law
  • Germany
  • All residents in Germany must legally have health insurance, either via the public health system or a private insurer in certain cases (e.g. self-employed, freelance and high earning workers are eligible for private health insurance). If your company has remote workers in Germany, you should take expert local advice on the type of health insurance they require and your contribution towards it.
  • Global nomads
  • Digital nomad health insurance now exists, with special plans designed for those who either work for an employer or are self-employed / freelancing while traveling. Workers in this situation may not be able to easily access local public health care or healthcare in their home country. They will therefore need some form of health insurance and this benefit could be a significant perk if you want to attract talented people who could be in this situation.

What remote health insurance options are available? 

If companies are going to provide health insurance for remote workers, there are a range of approaches they can take. Business and HR leaders need to make decisions around the type of insurance policy they provide, as well as their approach to benefit administration (e.g. direct or via a third party). Options to consider include:

1. Traditional health insurance

Employers can engage directly with an insurance provider and choose a health insurance plan compatible with their remote workforce requirements. This might be a straightforward option where there is an existing relationship with an insurance provider (e.g. provision of plans for on-site staff), the remote workforce are based in one country, and the company has an HR function able to handle employee benefits directly.

For a smaller company with little in-house HR resource, a newer start-up without any existing insurance company relationships, or any company with remote workers spread across several different countries, this option could prove time-consuming and challenging to administer. Traditional policies may not cover all remote working contingencies, or may do so ambiguously. Choose insurance plans and providers carefully to ensure they are fit for your purposes.

2. New generation remote worker health insurance

A new wave of health insurance providers is springing up, with the remote workforce directly in their sights. Companies like Horizons provide specialized insurance for remote workers and digital nomads, making a selling point of their flexible global coverage, online accessibility and ease of use for remote working compared to traditional health insurance products.

For smaller and/or newer companies, or individual remote workers themselves, this more modern approach may be easier both to navigate and scale up as necessary to cover a growing remote workforce, or multiple countries.  

3. Health stipends

In some cases, companies may wish to avoid directly setting up health insurance plans for some remote workers. For example, providing health benefits to contractors could lead to them being reclassified as employees, entailing legal and tax obligations for the business hiring their services.

In these instances, the hiring company may want to explore alternative options such as granting all remote workers a health stipend which can be spent on purchasing their own health insurance plan, or on wellness or sport activities if preferred. NB Expert local legal and tax advice should be taken before making decisions on health insurance and its alternatives.  

4. Health insurance provision via a local partner

Teaming up with a local partner is another way of providing remote worker health insurance when you don’t have the resource, expertise or desire to deliver directly. Whether you choose to outsource to an Administrative Services Organization (ASO) or to hire a Professional Employment Organization (where it is known as ‘PEO insurance‘) to become Employer of Record in a particular country, remote worker health insurance can be placed in local expert hands.

This approach could become complicated when you have remote workers operating across several countries or moving between them. Start-ups might need the flexibility of scaling up and down in several countries as they explore markets and establish their offer. Dealing with multiple local outsourcing partners each time can become a strain, eating up more time and effort than it saves.

5. Global PEO

Partnering with a global PEO can be a good choice for companies with remote workers in multiple countries, or where there may be expansion or contraction plans for your international network. Global PEOs have expertise in administering health insurance for remote workers around the work as well as delivering other HR, payroll and wider services. 

What challenges and risks should I be aware of around health insurance and remote workers?

If you decide to offer health insurance for remote workers there are some important issues to factor into your planning to ensure continued compliance, efficiency and workforce satisfaction.

  • Implications for local compliance
  • In the USA and some other countries, providing health insurance benefits might change the legal status of a contract worker in your organization so that they become classified as an employee for tax and legal purposes. This might then entail a range of unintended financial and contractual obligations for your company.
  • Complexity of the insurance industry
  • The insurance industry globally, and in individual countries, is heavily regulated and highly complex. Rules and regulations around health insurance and employee benefits more broadly can vary significantly between countries, or even between states or provinces within countries. Navigating the insurance environment, especially across multiple countries, is best accomplished with expert advice and local insight.
  • Staff movement implications
  • It’s important that both remote workers and employers are clear about the terms of any health insurance provided, including any reliance of coverage on location. If remote workers are going to move to another country, they must discuss this with their employer and insurance provider in advance. Carrying out work activities in any location not covered by the health insurance policy might lead to unexpected charges, lack of coverage, or delays in treatment.

  • Some policies might only be valid in the worker’s main country of residence. Others might be full “global nomad” policies allowing workers to work while traveling, but exclude specific countries (e.g. USA). Global nomad policies may exclude cover in a worker’s home country for anything except incidental travel over a specified number of days.


Whether you’re just beginning to think about health insurance options for your remote workforce, or you already have a plan you’d like to roll out, we’re here to help. As an experienced global PEO operating in 180+ countries, Horizons can provide benefits to all employees, including health insurance.

 Contact us today to discuss your needs and get a tailored quote. 

Frequently asked questions

Remote employees may require health insurance. This will depend on factors including their country of residence, nationality and level of earnings.

In countries with a universal public health system, health insurance may not be required (although it might still be offered as a perk, e.g. in Canada). In countries without this kind of health system, health insurance is likely to be required in some form. Employers may be legally obligated to provide health insurance, or they may choose to do so in order to attract and retain a strong workforce.

Remote workers require many of the same benefits as on-site employees. These include sick-pay, paid holiday and pension plans, as well as maternity and paternity leave, mental health support, and professional development training. They are unlikely to require or value benefits such as rail ticket loans or subsidies only valid for commuting to head office, or access to an on-site gym or other recreational facility at HQ.

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