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A few weeks ago, I took care of a patient who was on an international cruise when she became quite sick. She was hospitalized on a remote island for a few days before being medically evacuated back to the United States, where I met her. While she was happy to be back in the U.S., her family was particularly thankful for their travel insurance getting them back home. Despite my interest in wilderness medicine, I knew next to nothing about travel insurance. So I dove into the world of travel insurance to answer the questions: What's covered? What's not covered? How do I decide if I need it?

The first thing to know is that there are three different flavors of travel insurance: 1) Trip, 2) Travel Health, and 3) Medical Evacuation. With each flavor comes similar questions for consideration.

Trip Insurance

Most people have some experience with trip insurance. When booking a flight, one of the last options before submitting a payment is insuring your ticket for an additional fee, which can recoup the cost of your ticket if you must cancel (for one of the covered situations). However, more robust trip insurance is available to cover non-refundable trip expenses such as hotels, flights, and tours when a trip is canceled or interrupted. Some credit cards automatically offer this protection when using the card for bookings. However, eligible expenses, covered situations, and maximum coverage can vary greatly. Especially in the time of COVID, it is crucial to be aware of which reasons for trip cancellation are covered. If you are going on a self-planned expedition with minimal non-refundable expenses, it may be reasonable to forego this. Still, flights to remote locations can be expensive, and a plan with a lower maximum coverage may allow you to recover lost costs if you need to cancel. While trip insurance covers planned expenses, it won't help you with bills if you run into trouble once out on an expedition.

Travel Health Insurance

Healthcare emergencies are the primary cause for trip cancellation and interruptions, so while trip insurance might help with the lost costs from your trip, it won't do anything to cover your medical bills. Many private U.S. insurers will cover you while overseas, but it is essential to be aware of coverage requirements and potential exclusions. Some of these considerations include preauthorization before treatment or admission, policies regarding “out of network” coverage, coverage for injuries from high-risk activities, and preexisting conditions. People that find their current coverage to be insufficient for their expedition can purchase supplemental travel health insurance. These supplemental plans can offer protection for high-risk activities that you might be involved in on an expedition. They may also guarantee direct payment to hospitals (to avoid needing to foot a bill yourself and wait for reimbursement) and a 24-hour support center with a physician. Many of these plans will include medical evacuation insurance, but medevac has several considerations.

Medical Evacuation

If you're reading this column, chances are you've seen movies where a helicopter lands in a remote location to bring someone to the nearest hospital. This type of rescue is one aspect of medical evacuation insurance, getting you from a remote setting to “definitive” care, but depending on where you are in the world, “definitive” may not be the same quality you would be used to at home. In these instances, like with my patient, medical repatriation may be required, which could cost more than $100,000 without insurance coverage. Even with medical evacuation, it is not so simple, and you should ask some questions before purchasing a policy. Companies may have more experience in certain parts of the world and have little to no resources available in another, leading to delays in care, particularly in the remote locations you might find yourself in on expedition. It is also important to remember that medical evacuation insurance does not provide absolute protection. If weather conditions don't allow, or other unexpected delays arise, you may be stuck waiting, and so if the health risks are high, the best decision may be to stay home.

On an expedition, we often find ourselves in high-risk situations. However, we do everything we can to mitigate unnecessary risk while still giving us the experience we are seeking. For many, travel insurance offers a way to minimize the financial risks of an expedition. It is up to each adventurer to consider the exclusions to a policy and decide if the benefit is worth the cost.

WMS members are eligible for various benefits from Global Rescue, a WMS Partner. Learn more about their medical, security, and evacuation membership here.

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