Assurances on Your Insurance Coverage

It’s been called the most overlooked part of travel preparation: examining existing health insurance coverage to determine if it adequately covers emergencies away from home.

In a worst-case scenario, a traveler could need an airlift evacuation to reach specialized medical attention quickly. “I’ve seen evacuations [cost] up to $100,000,” said Richard Wallach of Wallach & Co., a Virginia firm that offers travel health policies. Of particular interest to travelers now, Wallach said, is evacuation coverage, as well as medical assistance services: help in finding an English-speaking physician or pharmacist abroad.

To be sure coverage is adequate, travelers are advised to follow a three-step process:

First, call a company representative to find out what your regular insurance policy covers.

Chances are good that the family health insurance plan also will cover travelers’ medical emergencies away from home, said Richard Coorsh, spokesman for the Health Insurance Assn. of America, a Washington-based trade group that represents many of the nation’s health insurance companies. (The exception is Medicare, which generally does not pay for hospital or medical services outside the United States and its territories, except for rare instances in Mexico and Canada, according to a Medicare spokesperson.)

But health insurance plans vary, and travelers may find that they need to pay cash up front and be reimbursed later, Coorsh said. And “medical emergency” is usually interpreted strictly.

Read the fine print on the insurance contract to determine what rules govern the coverage. At Kaiser Permanente, for example, subscribers must notify the health center within 48 hours of emergency care away from home or as soon as reasonably possible, spokesperson Linda Quon said. Medically necessary special transportation is covered, but prior approval from the medical group is necessary, she added.

Next, check with credit card companies. Many offer travel health services for cardholders.

For example, a service called Travel Emergency Assistance is available to American Express Platinum cardholders. With it they have toll-free telephone access to 24-hour medical assistance, including referrals to English-speaking physicians and dentists, hospitals and pharmacies.

MasterCard Gold cardholders can take advantage of MasterAssist, a service to help travelers get prescriptions filled and find doctors and medical evacuation services (but not pay for such services), said Michael O’Brien, a spokesman for MasterCard International.

Other cardholders receive travel assistance service too, O’Brien said, but cardholders should call and check on their specific benefits.

Finally, if there is a gap in coverage, a supplementary policy may be necessary. Numerous companies offer reasonably priced travel health policies.

A 14-day policy by Mutual of Omaha, for example, costs $22 and includes medical emergency coverage up to $4,000, said Joe Clauson. There is no deductible.

A Travel Assure plan, also offered by Mutual of Omaha, includes an eight-day family policy, with up to $10,000 in medical coverage, for $171, Clauson said. (For information: [800] 228-9792.)

A $100,000 medical expense benefit, at a cost of $3 per day with a 10-day minimum, is sold by HealthCare Abroad, a program administered by Wallach & Company. There is a $100 deductible, after which the plan pays 100% of expenses for covered injury or sickness, such as hospitalization, medical evacuation, home and doctor, surgeon and ambulance fees. (For information: [800] 237-6615.)

Before choosing a plan, read the fine print. Some travel health plans do not cover accidents or illnesses incurred during mountain climbing or other adventure travel. Dental coverage usually includes emergencies only, not routine care such as the filling of a cavity.

Pre-existing conditions often are not covered, said Wallach, although some policies will cover a chronic condition if it is deemed stable before departure.

Whatever plan is chosen, “pack a few copies of your health insurance company’s claim forms,” said Coorsh of the Health Insurance Assn. of America. In the event that emergency care is needed, make sure the forms are filled out legibly in English or Latin. And if taking a prescription drug, remember to take along adequate supplies for the length of the trip.

The Healthy Traveler appears the second and fourth week of every month.