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Special Report: Health Care Abroad

Insurance 101

By Barbara Benham

Having the right health insurance coverage is essential no matter where you are. Consider the retiree who fell down a manhole in Oaxaca. The college student with appendicitis who had to be evacuated by helicopter from Papua New Guinea. The IT executive whose hot-air balloon crashed in Kenya.

Yet, by some estimates as few as 5 percent of American travelers have health insurance coverage while they're abroad. According to Larry Akey, spokesman for the Health Insurance Association of America, most U.S. insurance plans—even the more comprehensive point-of-service plans—do not reimburse you for any medical expenses outside the country.

For this reason, travel agents, tour operators, cruise lines, and clinics across the United States sell a host of supplemental travel health insurance plans to cover you when your regular provider doesn't. But is extra coverage always necessary?And how do you know what kind of plan to get?

WHEN TO BUY

To determine if you need travel health insurance, first check with your insurer about whether you have international coverage. Mercifully, this is a more straightforward question than you'd think: the answer tends to be a simple yes or no (it's usually no).

Supplemental coverage isn't just for international travelers, either. Some insurance plans divide the United States into geographical "markets"—if you receive care from a doctor who accepts your insurance but isn't in your market, you might not be covered, and the doctor wouldn't necessarily be aware of this. Also, many plans do not extend to U.S. territories, such as Puerto Rico and the U.S. Virgin Islands. Although emergency treatment is sometimes exempt from such restrictions, it's a good idea to check on the rules with your insurance company before you travel, especially if you're in an HMO.

Separately, if you're insured through your employer, you should ask whether the company has already taken out travel insurance coverage. Your regular insurer might not know about this, since travel insurance is sometimes arranged through a different company.

If you find out you're not covered abroad or in a particular region of the country, it is prudent to consider purchasing supplemental insurance. And if you're going to a remote area or a country where medical standards are not high, you might also think about signing up with a medical evacuation service, which will help arrange and finance transportation to a hospital. See "The Fine Print," below, for more on how to evaluate your options.

WHAT TO BUY

Supplemental travel health insurance generally comes in three forms:

• A per-trip or annual plan, to cover medical expenses and/or evacuation, that you purchase directly from a provider.

• A customized plan, typically including trip-cancellation insurance and sold by a tour operator or cruise line you've booked with. One of the biggest providers is BerkelyCare, which designs plans for companies such as Tauck World Discovery and Silversea Cruises.

• A bundled package—travel health and trip-cancellation insurance—that you buy yourself from a large travel-insurance firm such as Travel Guard International.

Prices vary but tend to be based on your age, the length of your trip, and the amount of coverage. Location can also be a factor, especially with custom plans. The State Department publishes a useful guide to insurance options (available on-line at travel.state.gov/medical.html); see also "A Guide to Travel Medical Providers," below, for basic plans from leading companies.

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