When Esther LoVerme planned a Royal Caribbean cruise with two friends, the last thing she expected was to need emergency surgery in Russia. But being an old hand at traveling, she signed up for the cruise line’s trip insurance, CruiseCare.

Because of that pre-trip decision, when Esther developed an acute gall bladder infection as the cruise neared St. Petersburg, the ship’s doctor contacted a previously vetted private hospital there, and an ambulance met her at the dock.

“English-speaking doctors stayed in touch with my family, and after surgery and a few days’ recovery time, CruiseCare arranged for my flight home, in business class and with a nurse who stayed with me right to my own door.

“The insurance was absolutely a bargain,” Esther says, “And not just for the cost of the flight. They coordinated everything with the hospital and with my husband back home, and the hospital they’d selected handled details like getting my day-visit visa extended. Royal Caribbean staff even called me at the hospital afterward to be sure I was okay. And they are refunding the cost of the part of the cruise I missed.”

Expecting the unexpected is what travel insurance is all about. While most cruise lines and tour companies offer insurance that covers a variety of contingencies from last-minute cancellation to medevac by helicopter, independent travelers have a wide range of options, too.

Typically, basic travel insurance addresses two kinds of risk — medical emergencies and trip cancellation — and the two are often packaged together. Some, especially those sold by cruise lines and tour operators, also cover flight cancellations to embarkation ports, loss or delay of luggage or sports equipment, and loss or theft of travel documents, as well as various other non-medical benefits.

TravelSafe, for example — in addition to $100,000 emergency evacuation and repatriation, $35,000 accident and sickness medical expense insurance and emergency assistance — rolls trip cancellation/interruption, missed connection, travel delay and baggage insurance into its most basic plan.

Instead of trip-by-trip coverage, frequent travelers usually opt for an annual policy that covers them whenever they are traveling abroad. Again, these range from medical evacuation only to policies covering a full range of potential travel losses. Allianz Global Assistance, formerly AccessAmerica, offers a basic medevac policy covering emergency medical transportation up to $1 million and travel home after evacuation, with worldwide 24-hour hotline assistance. Its Full Medical Deluxe Annual Plan adds $20,000 in emergency medical and dental coverage, $25,000 travel accident coverage, $300,000 flight insurance, trip interruption/ cancellation/delay coverage, plus baggage insurance and even rental car collision damage waiver insurance.

Coverage goes beyond treatment for severe illness or accidents. Most plans include an emergency number to call for referrals to doctors or dentists who speak your own language, or help getting an emergency prescription filled. Travel Guard’s MedEvac plan also includes Security Evacuation coverage if a destination becomes unexpectedly dangerous because of political unrest or natural disasters, although this feature is not available for policies written in some states.

Plans vary not only in what they cover but also how they cover it. Esther LoVerme’s insurance will reimburse her for the hospital expenses (which she had to pay by credit card) after her own primary medical insurance reimburses its portion. She paid nothing for the flight home, but CruiseCare is a secondary insurer for her medical bills. Some plans don’t cover the cost of any but emergency treatment; some cover only the transportation, without any medical insurance coverage. Plans vary on the extent of the medical evacuation, too. Some transport to the nearest hospital (which may not be the best one), others to the nearest hospital of your choice, and some to your own home hospital if you request it.

Several companies’ plans cater specifically to business travelers. Travelex business traveler protection includes single- and multi-trip plans with customizable upgrades to fit individual needs. The basic business plan includes the usual coverage for medical evacuation plus trip interruption and delay and special insurance for business property such as laptops and PDAs. In addition, there is $2,000 in lost or delayed luggage insurance with a $600 per-item limit, which is higher than most of its competitors’ limits. The plan also includes 24/7 concierge service anywhere in the world to help with emergency travel arrange ments, interpretation services and even dining recommendations and information on golf courses.

Distinct from insurance plans, MedjetAssist is a membership program that offers a different set of medical evacuation and health services specifically designed for frequent travelers. Unlike insurance, it arranges medical evacuation and repatriation for its members, both worldwide and domestically if traveling more than 150 miles from home (most insurance plans are only for foreign travel), and allows members to choose the hospital they will be evacuated to, which can be their home hospital even if equally good facilities are closer.

Of special importance to those traveling in remote or distant places, unlike insurance policies, there are no limits to the air-ambulance evacuation costs covered. Another difference is MedjetAssist members are transferred without regard to medical necessity. As long as they are hospitalized as an inpatient, they can choose to be transferred to another hospital. Health and travel insurance plans require a transfer be medically required; and if a closer hospital is deemed adequate by the insurer (not the insured), transferring to another is usually not an option.

Additionally, MedjetAssist medical staff monitor the member’s condition and treatment and consult with both the family and the local attending medical provider until the situation is resolved and the member is either able to resume travel or is transferred home. Services also include foreign-language interpretation when communicating with local medical providers and emergency message relay with relatives, friends and business associates. And although no traveler wants to contemplate this, MedjetAssist provides full repatriation coverage in case of death, a feature also included in many medical evacuation insurance plans.

Most insurers offer a choice of levels of coverage. Travel Guard’s Gold Plan, for example, upgrades the MedEvac Annual Plan to provide higher policy limits; coverage for trip cancellation, travel delays and lost luggage; and covers children at no additional cost. MedjetAssist’s Elite membership adds a 50 percent discount for Vaccines on the Go, providing in-home or office “house calls” for pretrip immunizations, as well as cash advances for medical emergencies and pre-trip personalized travel advisories with e-alerts about events that could affect travel plans or safety. Elite members also have access to secure online medical and vital health information storage.

An area of travel medical insurance often misunderstood is the need for extra coverage for hazardous sports and pre-existing conditions. Is skiing, for example, considered hazardous, and does someone who had a heart attack two years ago need extra pre-existing condition coverage? The answer to both may be “no,” according to Squaremouth, a website dedicated to comparing travel insurance. Most major insurers do not list skiing as a hazardous sport unless you (or a family member) plan to enter a ski race, even an amateur or children’s competition. Heliskiing is usually listed among hazardous sports, however, along with motorcycle or motor scooter riding, mountaineering, parachuting, hang gliding and bungee jumping.

The key to whether travelers need to pay extra for a pre-existing medical condition is the look-back period for defining pre-existing, which on many policies, including Travel Guard’s, is only 180 days prior to the effective date.

But, warns Chris Harvey, CEO of Squaremouth, “Nearly half of the travel insurance providers will require travelers to have pre-existing coverage if they want to be able to cancel due to a non-traveling family member’s pre-existing condition.” In these situations, Squaremouth recommends looking for a policy that only defines the travelers themselves as those who need pre-existing coverage and doesn’t look to see if a non-traveling family member’s illness resulted from a pre-existing condition. Also, if a traveler does require pre-existing coverage, it’s important to buy it early, since nearly all travel insurers require a policy to be purchased within 14 to 30 days from the first trip deposit for pre-existing coverage to be available.

It is always important to check the fine print, which both Squaremouth and QuoteWright websites help prospective buyers do by comparing a number of carriers’ various plans.

Both sites remind travelers price should not be the only basis for selecting travel insurance. First determine which of the many features are crucial to a safe and worry-free trip, then compare policies, looking for those features. QuoteWright not only allows shoppers to compare the plans and their coverage limits on a chart but also shows the underlying policy wording on a side-by-side basis.

The few minutes of considering what’s important to you and comparing options to be sure you have the best coverage could be the most important time spent in pretrip planning. No traveler expects to be sick or injured on the road, but it’s nice to know if the unexpected happens, there is someone there to make sure you are well cared for and return home safely.

Weblinks

Allianz Global Assistance
MedjetAssist
MedjetAssist Elite
QuoteWright
Squaremouth
Travelex
Travel Guard
TravelSafe