Chapter 2The Pre-Travel ConsultationCounseling & Advice for Travelers
Travel Insurance, Travel Health Insurance, & Medical Evacuation Insurance
Severe illness or injury abroad may result in a financial burden on travelers. Although planning for every possible contingency is impossible, travelers can reduce the cost of a medical emergency by considering the purchase of 3 types of insurance for their trip: travel insurance, travel health insurance, and medical evacuation insurance. These insurance policies can be purchased before a trip to provide coverage in the event of an illness or injury and may be of particular importance to travelers with chronic medical conditions. Basic accident or travel insurance may even be required for travelers to certain destinations.
Travel insurance protects the financial investment in a trip, including lost baggage and trip cancellation. Travelers may be more likely to avoid travel when sick if they know their financial investment in the trip is protected. Depending on the policy, this type of insurance may or may not cover medical expenses abroad, so travelers need to carefully research the coverage offered to determine if additional travel health and medical evacuation insurance is needed.
PAYING FOR HEALTH SERVICES ABROAD
Medical care abroad usually requires cash or credit card payment at the point of service, regardless of whether the traveler has insurance coverage in their home country. This could result in a large out-of-pocket expenditure of perhaps thousands of dollars. Additionally, the existence of nationalized health care services in a given destination does not ensure that nonresidents will be given full coverage. When paying out-of-pocket for care, travelers should obtain copies of all bills and receipts and, if necessary, contact a US consular officer, who can assist US citizens with transferring funds from the United States.
The possibility of these large out-of-pocket medical expenses makes a discussion of insurance options an important part of any pre-travel consultation. Although insurance should be a consideration for all travelers, it is particularly important for travelers who are planning to be outside the United States for an extended period of time, have underlying health conditions, or plan to participate in high-risk activities on their trip.
DOMESTIC HEALTH INSURANCE
Some health insurance carriers in the United States may provide coverage for emergencies that occur while traveling abroad. Travelers should carefully examine their coverage and planned itinerary to determine exactly which medical services, if any, will be covered abroad and the level of supplemental insurance needed. The following is a list of characteristics to consider:
- Exclusions for treating exacerbations of preexisting medical conditions
- The company’s policy for “out-of-network” services
- Coverage for complications of pregnancy (or for a neonate, especially if the newborn requires intensive care)
- Exclusions for high-risk activities such as skydiving, scuba diving, and mountain climbing
- Exclusions regarding psychiatric emergencies or injuries related to terrorist attacks or acts of war
- Whether preauthorization is needed for treatment, hospital admission, or other services
- Whether a second opinion is required before obtaining emergency treatment
- Whether there is a 24-hour physician-backed support center
SUPPLEMENTAL TRAVEL HEALTH AND MEDICAL EVACUATION INSURANCE
Short-term supplemental policies that cover health care costs on a trip can be purchased, and are relatively inexpensive. Medical evacuation coverage may be purchased separately or in conjunction with travel health insurance. Domestic insurance policies may not cover medical evacuation from a resource-poor area to a hospital where definitive care can be obtained, which can cost more than $100,000. Frequent travelers may want to consider purchasing annual policies or even policies that will provide coverage for repatriation to one’s home country.
Medical evacuation companies may have better resources and experience in some parts of the world than others; travelers may want to ask about a company’s resources in a given area, especially if planning a trip to remote destinations. The traveler should scrutinize all policies carefully before purchase, looking for those that provide the following:
- Arrangements with hospitals to guarantee payments directly
- Assistance via a 24-hour physician-backed support center (critical for medical evacuation insurance)
- Emergency medical transport to facilities that are equivalent to those in the home country or to the home country itself
- Any specific medical services that may apply to their circumstances, such as coverage of high-risk activities
Even if an insurance provider is selected carefully, travelers should be aware that unexpected delays in care may still arise, especially in remote destinations. In special circumstances, travelers may be advised to postpone or cancel international trips if the health risks are too high.
FINDING AN INSURANCE PROVIDER
The following resources, although not all-inclusive, provide information about purchasing travel health and medical evacuation insurance:
- Department of State (www.travel.state.gov)
- International SOS (www.internationalsos.com)
- MEDEX (www.medexassist.com)
- International Association for Medical Assistance to Travelers (www.iamat.org)
- American Association of Retired Persons (www.aarp.org) (for information about Medicare supplement plans, see below)
SPECIAL CONSIDERATIONS FOR TRAVELERS WITH UNDERLYING MEDICAL CONDITIONS
Travelers with underlying medical conditions should take extra precautions in preparing for travel. These travelers should choose a medical assistance company that allows customers to store their medical history before departure, so it can be accessed from anywhere in the world. Travelers should carry a letter from their physician listing their medical conditions and current medications (including their generic names), written in the local language if possible. Those with cardiac disease should carry a copy (paper or electronic) of their most recent ECG. They should also pack all medications in their original bottles, checking beforehand with the destination’s embassy to ensure that none are considered illegal narcotics in the destination country.
SPECIAL CONSIDERATIONS FOR MEDICARE BENEFICIARIES
The Social Security Medicare program does not provide coverage for medical costs outside the United States, except in limited circumstances. Some Medigap plans may provide limited coverage for emergency care abroad. As with all travelers, Medicare beneficiaries should examine their coverage carefully and supplement with additional travel health insurance as needed.
CHECKLIST FOR DISCUSSING INSURANCE WITH TRAVELERS
The following checklist can be used for guiding an insurance discussion during a pre-travel consultation. In short, travelers should:
- Consider travel, travel health, and medical evacuation insurance.
- Scrutinize their domestic health insurance policy to see what medical services may or may not be covered abroad.
- Locate medical services in areas that they plan to visit and carry this information with them on their trip.
- Carry copies of their insurance policy identity cards, including any supplemental insurance purchased for a trip, and insurance claim forms.
- Retain copies of all bills and receipts for medical care received abroad.
- American Association of Retired Persons, Education and Outreach. Overview of Medicare supplemental insurance. Washington, DC: American Association of Retired Persons; 2010 [cited 2012 Sep 18]. Available from: http://www.aarp.org/health/medicare-insurance/info-10-2008/overview_medicare_supplemental_insurance.html.
- Centers for Medicare and Medicaid Services. Medicare coverage outside the United States. Baltimore: CMS; 2010 [cited 2012 Sep 18]. Available from: http://www.medicare.gov/Publications/Pubs/pdf/11037.pdf.
- Leggat PA, Carne J, Kedjarune U. Travel insurance and health. J Travel Med. 1999 Dec;6(4):243–8.
- Teichman PG, Donchin Y, Kot RJ. International aeromedical evacuation. N Engl J Med. 2007 Jan 18;356(3):262–70.
- US Department of State. Medical insurance. Washington, DC: US Department of State; 2010 [cited 2012 Sep 18]. Available from: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html.