The ins and outs of emergency medical evacuation coverage

Basics of evacuation coverage

Emergency medical evacuation service is very rarely needed but can be extremely expensive. It is one of the travel emergencies usually not provided for in your “at home” health insurance coverage.

For purposes of this article, the term “emergency medical evacuation” will also include “repatriation.”

Insurers define emergency medical evacuation as transportation to where the nearest appropriate medical treatment can be provided, by the most direct and economical route possible.

Repatriation is the medically required transfer of a patient to his home or to an American hospital. Repatriation all the way home would usually only be provided if the closest-available medical treatment would only stabilize a condition and if further treatment would be required for full recovery. If the first-available medical treatment facility appears to be adequate for near-term recovery, medical monitoring and other support will be provided but no additional transportation will be provided. For evacuation or repatriation, a patient on a stretcher or with a large cast on a major broken bone may be provided with four first-class seats on a commercial flight, with another for a companion. Other transportation could be provided by one of a worldwide fleet of available private air ambulances and by land ambulance or private motor vehicle, and, when necessary, with the accompaniment of appropriate medical personnel.

The greatest number of travel medical emergencies are successfully dealt with without the major function of air evacuation.

How do evacuation providers function?

TRAVELER’S EMERGENCY NETWORK (or TEN; phone 800/275-4836, or visit www.tenweb. com) and other sellers of emergency evacuation services do not have their own airplanes, of course. They contract out these services to “providers” (who also aren’t likely to have their own airplanes). These providers are “insured,” or the services are guaranteed to be paid by large insurance company “underwriters.” But let’s not get this too complicated.

TEN, for example, contracts with WORLDWIDE ASSISTANCE for actual emergency services. When you call the emergency number provided by TEN, it connects you to the Worldwide Assistance emergency center in Washington, D.C. The subsequent medical monitoring and/or assistance contact may then be transferred to a center closer to your emergency location.

When an emergency contact is initiated, the Stateside provider opens a file on the details and timing of contacts with you and the appropriate medical providers.

Preapproval of emergency services is always required. Do not make arrangements on your own that you will expect the provider to pay for! They won’t.

The emergency “suppliers” can be enormously helpful in supplying other medically related support that will lessen the stress of a problem in a foreign country.

If you are traveling alone and are hospitalized for more than seven consecutive days, a program may pay for round-trip transportation of a designated companion to your hospital.

If you’re hospitalized and it’s necessary for your traveling companion to remain with you (interrupting their prearranged travel itinerary), evacuation-only programs will usually pick up the cost of the companion’s and the patient’s cost of rescheduling a return flight but not the “trip interruption/trip cancellation” loss.

Stand-alone emergency medical evacuation coverage does not provide for any costs of medical care itself. (“Travel assistance” programs supplied by credit cards will provide assistance in locating help in travel emergencies but will not pay for medical or any other travel-related costs.) 

How rare is the need for evacuation?

Statistics from the U.S. Travel & Tourism Agency, the State Department and a travel insurance company suggest that the odds of an American traveler even being hospitalized on a trip overseas is less than 11⁄2 hospitalizations in 1,000 trips!

In a senior population, this number probably increases up to maybe as much as 10 per 1,000 trips (my estimate). Not all of these would have required emergency medical evacuation.

A major travel insurance provider might have to arrange one medically required transfer every day. One insurance provider provided the statistic that in a 2-year period, they had about one evacuation for every 1,800 policy holders.

Until 1992, $10,000 of emergency medical evacuation coverage was supplied with a Mastercard “Gold” card at no extra cost! Apparently, this expensive evacuation is rare
enough for other suppliers to be able to offer it at modest cost.

How much do evacuations cost?

Some evacuation providers have maximum dollar limits in the range of $20,000-$25,000, while quite a few have $100,000 or unlimited maximum limits. How to choose?

Emergency medical evacuation providers quote somewhat conflicting examples of what your exposure might be without their protection. They seem to agree that the most common range for evacuation costs is between $3,000 and $15,000. A Lear jet is not necessary if first-class accommodations on a commercial flight meet the medical and other requirements. Travel Guard, which has a $20,000 evacuation limit, said that in the past two years they provided 460 evacuations and none exceeded their policy limits.

Evacuation providers also seem to agree that, other things being equal, evacuation costs can vary widely, depending on where the emergency occurs.

The Orient, parts of Africa and other locations that are easily defined as remote, very distant from the U.S. or which have some other financial/political/infrastructure difficulties can generate unusually expensive evacuation costs. When pressed, the providers with lower maximum limits agree that for travel in the above-described parts of the world, purchasing a higher limit policy would be prudent.

Alternatives to purchasing evacuation coverage

Medicare, of course, does not pay for any overseas medical claims. Some “Medigap” plans provide for preapproved overseas evacuation, but you may have to pay the costs up front and file a claim for reimbursement (with all the appropriate paperwork in English).

Your HMO or other health insurance provider may allow for some evacuation costs (Kaiser does — on a case-by-case basis); check with your at-home provider, well before an overseas trip, and ask if they have a brochure describing how to deal with overseas medical emergencies.

(Some overseas hospitals will not release a patient until all costs are paid in full.)

If you already have what you feel is reasonable coverage of medical emergency costs overseas, you may well decide to not purchase additional coverage, but be sure to travel with a decent amount of extra cash and/or travelers’ checks and a credit card that has a generous available balance. Many credit cards will increase limits on short notice in case of emergencies.

For further information, see the articles “Overseas Health/Accident Insurance — What Seniors Need to Know,” Nov. ’97, page 58, and “Consider the Odds When Buying Travel Insurance,” Aug. ’94, page 37 (or send $2 to my attention at ITN for reprints).

ITN readers’ concerns

ITN has received a number of letters from readers recently regarding problems or concerns about emergency medical evacuation services. The topics most often mentioned were a) disappointment that the medical evacuation coverage supplied by TEN is now not only more expensive but also no longer available for those 75 years old or older, and b) dissatisfaction with or misunderstanding of the details of emergency medical evacuation services.

TEN and alternatives

Until 1999, the cost of TEN’s membership for a year was $45 for one person ($30 in previous years) and $69 for an entire family. (TEN’s definition of family is spouse and children and does not include two siblings living together, for example.) Effective Jan. 1, 2000, however, the cost of a year’s  TEN membership will be $99 for one person or a family. The maximum dollar amount of coverage was previously unlimited, but it is now a maximum of $100,000.

The primary service provided by TEN is emergency medical evacuation (with a preexisting-medical-condition clause effective as of April 1999), but they also provide a variety of additional travel planning and travel/medical assistance functions. TEN offers their planning, general assistance-only package for a year for $49.

75-and-older alternatives

Since we all hope to be, or are, active travelers at age 75 and beyond, having access to prepaid emergency medical evacuation service (without a preexisting-condition clause) is a
comfort when far from home and away from medical treatment that is known to be reliable.

The following companies will provide emergency medical evacuation services, without an age limit, as part of limited-term travel insurance packages.

ACCESS AMERICA (phone 800/284-8300), TRAVEL ASSURE (800/228-9792), TRAVEL GUARD (800/826-1300), TRAVELEX (800/797-4515), and TRAVEL INSURED (800/243-3174).

CSA TRAVEL PROTECTION (800/348-9505) offers the usual travel insurance packages, with a twist: trip-cancellation insurance rates vary with age. At age 55 or younger, rates are as low as 21⁄2%. Rates increase with age but stay competitive even up to age 75. CSA claims that these are the lowest travel insurance rates available to consumers in the U.S.

UNIVERSAL TRAVEL PROTECTION (800/211-8952, or visit www.utravelpro.com) has a package of travel insurance protection with costs that are age-related. They claim to offer lower costs because they eliminate the significant commission usually paid to travel agents.

TRAVEL SAFE (800/234-0375) also has an age-related sliding scale of travel insurance rates.

The above companies will waive the preexisting-medical-condition clause if you purchase their package within some specific time limits (typically within seven to 14 days of making a deposit on a tour package). For independent travel, the time limit for purchasing insurance with a preexisting-condition waiver starts with the first purchase of air-fare or deposit on any lodgings, etc.

Terms and conditions of travel insurance policies are subject to change (fortunately, in the last few years these changes have been in favor of the traveler).

If this type of travel insurance package is for you, it would pay to call and ask for several of these companies’ brochures to compare costs and coverages, or to discuss these variables with your travel agent (who may or may not be pushing” one company’s policy).

Stand-alone medical evacuation service

For evacuation coverage alone, WORLDWIDE ASSISTANCE (800/821-2828, or visit www.worldwideassistance.com) offers coverage without an age limit and without a preexisting-medical-condition clause. Costs depend on the period of the coverage: from $21 for an individual for an 8-day trip to $162 for family coverage for a year.

(An annual program will not usually provide for a year’s continuous coverage. You can take multiple trips within a year, but none can be longer than 90 days’ duration. For longer-duration trips, an expatriate program or a different rate would be required.)

Worldwide Assistance also allows the flexibility of adding optional travel insurance coverages. (They do not, however, waive the preexisting-condition clause on their medical benefits coverage.)

INTERNATIONAL SOS (800/523-8662, or visit www.internationalsos.com) supplies service for one to 14 days for an individual for $55, for a couple for $96 or for a family for $144. Contact them for other rates.

These are reasonable alternatives to TEN’s evacuation coverage for the over-age-75 set. For those under 75, here are a few more alternatives.

MEDEX (800/537-2029, or visit www.medexassist.com) provides individual stand-alone evacuation service for one to 14 days for $30, but there is an age limit of 75.

The auto club AAA in Northern California offers a “plus” package that includes up to $10,000 in emergency medical evacuation coverage. The auto club will not include the spouse in the coverage unless he or she is a “co-member.” Contact your local auto club to see if this is available in your part of the country.

Travelers’ responsibilities

STAY IN CONTACT: Make sure that you have the appropriate emergency contact phone number available and stay in touch with the provider’s contact.

They have to know how to keep in touch with you — remember, in a stressful situation it’s easy to overlook this critical detail. Suggest use of fax or messages left at the front desk if they can’t catch you in a hotel or hospital room.

Case history example

In February ’99, ITN subscriber George Cain of Maxwell, CA, had a medical emergency on a cruise ship. He and his wife, Olga, were transferred by the ship to a hospital in Santa Cruz de Tenerife, Canary Islands.

They called the TEN emergency number for assistance and asked for help, particularly since there was a significant need for language translation.

To summarize their part of a long ordeal, the Cains were not able to maintain good contact with the TEN emergency assistance provider, Worldwide Assistance, and therefore did not feel that they received adequate help.

Fortunately, they managed to struggle successfully through the problem with a lot of gumption and a Spanish translation dictionary. And, fortunately, the medical care that George received was “wonderful” (to use Olga Cain’s word).

A letter from the Cains to ITN prompted me to contact Worldwide Assistance. Worldwide Assistance sent me a 13-page printout of the detailed record of their activities on the Cains’ behalf.

To condense the record, after receiving the initial call they collected two pages of initial information regarding George Cain’s problem, his location and the medical contacts in the Canary Islands. Worldwide Assistance records fill an additional 11 pages with 86 individual entries of various case-related communications and contacts (or attempts at contact) with the patient’s doctors/hospital and to Olga Cain during the next 24 days of George’s hospital and hotel recuperation.

Worldwide Assistance kept track of George’s condition and treatment and were preparing to provide air evacuation, had it been necessary.

The primary area of Olga Cain’s dissatisfaction, when they finally got home, was that she felt she had not been assisted with the language problem and was not adequately kept advised of Worldwide Assistance’s activities on George’s behalf. My review of the records confirm the difficulty that Worldwide Assistance had in keeping in touch with Mrs. Cain and the local medical personnel.

How to minimize communication problems

In summary, if there is a lesson here, it’s that if a traveler is not getting satisfactory communication from the Stateside provider, it would be to everyone’s advantage for the patient (or companion) to make whatever number of attempts are necessary to keep in contact with the provider. 

Travelers are provided with a toll-free number or an emergency number to call collect. (Although some “800” numbers do not work in many parts of the world, AT&T has a wallet card that has numbers to be dialed from various countries that will connect you directly to a Stateside operator for ease in making calls to the U.S. This is worth picking up to have on hand.)

Considering the hospital/hotel location movements of the patient and/or the partner, keeping in touch with the Stateside provider is tough, especially during a stressful period. Stress really isn’t the appropriate word; “panic” was the word used several times during my phone conversation with Olga Cain.

Don’t make communication the principal responsibility of the Stateside provider. George Cain’s recommendation, after having time to consider their problem, is to “call them eight or 10 times” or until you get and keep satisfactory communication.

The Cains have also joined IAMAT (International Association of Medical Assistance to Travelers), a donation-funded organization that supplies lists of English- speaking doctors in many countries. For further information, contact IAMAT at 417 Center St., Lewiston, NY 14092; phone 716/754-4883.

Typical fine print

For the compulsive reader, or the very thorough travel-insurance-purchasing researcher, I have available a 10-page set of “fine print” supplied from Worldwide Assistance (WA) that is typical of insurance providers. Send me a business-sized, self-addressed, stamped envelope for a copy of the “brief” statement of conditions.

Even here there is a wordy disclaimer: “WA reserves the right to suspend, curtail or limit its services in any area in the event of rebellion, nuclear accidents, acts of God (their definition, not God’s — Wayne’s comment), or refusal of authorities in the country of assistance to permit WA to fully provide services. WA will, however, endeavor to provide services in the best of its ability during any such occurrence. It is the responsibility of the member to inquire whether a country is ‘open’ for assistance prior to his or her departure. WA’s services are not currently available in some countries. . . (list subject to change, please call for an updated list.)”

Even these 10 pages are not the final text of the provisions of coverage. To further quote, “Policy terms and conditions are briefly (?— Wayne’s comment) outlined in this Description of Coverage.” “Complete provisions pertaining to this insurance are contained in a Master Policy (sealed in a mason jar under Aunt Maude’s porch. . . It’s mind-numbing, but insurance is a complex agreement, written by the insurer’s attorneys — Wayne’s comment) on file with the trustee, Bank of Edwardsville, Illinois.”

“In the event of any conflict between this Description of Coverage and the Master Coverage, the Policy will govern.”

My wife and I are looking at age 65 in the rear-view mirror. We don’t go overseas without emergency medical evacuation coverage.

Happy trails.