Health Insurance for Same Sex Partners of Foreign Service Officers: Experiences and Lessons Learned

Health Insurance for Same Sex Partners of Foreign Service Officers: Experiences and Lessons Learned

By: Chris



In 2009, President Obama and Secretary Clinton extended limited benefits to the same sex domestic partners of U.S. Foreign Service Officers (FSOs).  To do this, Secretary Clinton expanded the definition of Eligible Family Member (EFM) to include the same sex domestic partners of FSOs.  Now the same sex domestic partners of FSOs receive the benefits extended to all EFMs (e.g. emergency evacuation, visits to medical units at posts, and funds for medical clearance).  However, the U.S. government still does not provide health insurance for EFMs, and therefore, across the world, the committed same sex domestic partners of FSOs must purchase personal international health insurance at great cost and effort.

Purchasing personal international health insurance is a complicated and frequently confusing process that requires a great deal of research to ensure satisfactory coverage.  There are many health insurance companies with widely different terms, premiums, deductibles, and geographical areas of coverage.  The experience of, and best plan for, each individual is also unique based on age, pre-existing condition, location, etc.  As a 39-year-old same sex domestic partner of an FSO, I am sharing my experiences from the last eight years in the hope that others will benefit from understanding the lessons I have learned and the two key issues I have faced: rising costs and restrictive coverage.

Rising Costs

Some insurance companies attract potential customers with low premiums, but increase premiums dramatically once claims are filed.  Therefore, I advise seeking international health insurance from a company that guarantees that its premium will only increase according to the age or age group of the insured, regardless of claims made or medical conditions that may develop. If you do not currently have a serious pre-existing condition, I suggest switching to a company that offers this guarantee immediately.  It is important to ensure that you get this agreement – guaranteeing limited premium increases – in writing.


My experience with rising costs demonstrates the importance of such guarantees.  In 2003, at our first post, I purchased health insurance from International Medical Group (IMG).  The premium cost was reasonable (around $1,300 per year) with a deductible of $500.  The medical coverage was comprehensive with full international coverage including North America.  This insurance served me well at first.  However, two years later I had a major operation to stabilize a spinal condition. The condition was neither chronic nor life threatening, and did not require continued treatment.  Following the operation, I submitted claims where my medical costs exceeded the deductible.   None of the claims were extraordinary, with the exception of the major operation that cost $10,000, and the claims process went very smoothly.  However, as a result of this operation, my premium started to increase by 20% each year, even without additional claims.  In order to keep the premium low, we were forced to raise the deductible quite substantially.  Despite our efforts, in 2007 the premium nearly doubled from the previous year.  We called IMG for an explanation of the increase in cost, as the premium they were going to charge us was about $3,500 more than the average premium for a new applicant of my age. IMG said the difference was due to my pre-existing conditions.  Since I was in very good health and I did not require any expensive treatments, I decided that the premium was overpriced and unjustified.  I decided to shop around to see if I could get a better deal.

In 2008, I switched to William Russell, a U.K.-based international health insurance company.  The main reason I chose William Russell among all the options was that the company promised to limit the annual increase in premium according to my age, regardless of claims made during the coverage period.  In other words, the company will not charge extra for any future pre-existing conditions after two years of continuous coverage, and will keep the premium consistent with that of a new applicant of the same age.  Ultimately, I decided that, since I was in good health, and because William Russell had very comprehensive coverage, I made the switch.

I am now paying a premium of about $1,200 with a deductible of $1,600.  I have not made a claim with William Russell and my current premium increase is limited to 5-10% per year.  A drawback to health insurance through William Russell is that it does not cover health needs when in North America.  Given that my partner is not likely to be posted to Washington in the near future, this worked for us.  However, if we were to be based in the U.S. we would need to seek different or extra coverage.

Restrictive Coverage

Unlike the health insurance options provided to Federal employees and their children and opposite-sex spouses, there is, to my knowledge, no international health insurance company that will cover pre-existing conditions.  This limitation makes switching policies exceptionally tricky if you have any medical condition, or a medical history that includes a serious illness or operation.

When I wanted to switch from IMG in 2007, I found Clements to be very reasonably priced and the coverage sufficiently comprehensive – it even included coverage for North America.  However, Clements rejected my application based on my pre-existing condition.  While William Russell would not cover my pre-existing conditions, they did accept my application.


No health insurance plan comes close to approximating the coverage and low costs of the Federal health insurance offered to married opposite-sex partners.  The same sex domestic partners of FSOs must therefore research all of their options carefully before selecting a health insurance company.  During the selection process, take stock of your personal situation (age, pre-existing condition, location, required coverage etc.), be aware of the potential for rising costs and restrictive coverage, and make an informed decision.  Please also share your experiences with health insurance with the GLIFAA community by e-mailing your story to  By sharing our experiences we can ensure the best coverage and experiences for our members.