Selecting travel health insurance — sorting out your options

By Wayne Wirtanen
This item appears on page 28 of the May 1991 issue.

There’s a basic philosophy that will keep one from being “insurance poor,” and that is this: insure youself only against losses that you can’t afford.

Approaching health insurance

Most regular health insurance pol­icies extend their coverage to costs incurred anywhere. They may require you to pay for medical expenses up­front, but they’ll reimburse based on their normal coverage.

Trip cancellation policies, with a cost of 5'/2% to 8% of the trip cost, may pay as little as a fraction of your pre­trip deposit... if you can get past the fine-print conditions.

The most important thing for which to provide is a serious (read expensive) health problem in some part of the world where language and/or limited medical facilities present a serious impediment to proper care. 

One way to do this is to leave home with a means of referral to the best English-speaking medical services available plus access to large, un­anticipated up-front cash needs and some access to rarely needed but potentially very expensive, sudden air evacuation to the U.S. The re­ferrals will help, of course, in minor emergencies, also.

These can be provided in a cost- effective way by some combination of a “Gold” credit card and an under­standing of how to utilize your normal health insurance coverage.

Review the summary of overseas health offerings that follows and select a policy only after determining that it will supply a real advantage. The time to study the fine print is before purchase, not when you sud­denly have an emergency. Don’t rely solely on your travel agent; if you sort through the following information and read the fine print in a couple of brochures, you'll be the expert.

In most cases, if you have regular health insurance, buying an addi­tional overseas policy is of limited value, since most of these provide only “secondary coverage”; that is, they pay only what your normal insurance does not.

(A major advantage is that most overseas policies will pay your bills overseas and then settle with your normal insurer later. You must make sure that you take your “hot line” phone number with you and under­stand who pays what and when.)

The “preexisting condition”

A serious shortcoming of many overseas trip insurance policies (in­cluding trip cancellation) is that they won’t pay a claim that’s related to what they define as a “preexisting condition.”

Any medical problem, medication use, doctor’s visit or record of symp­toms will void the coverage of a health (or trip cancellation) policy if your claim can be interpreted as related to any of these within the six months prior to the trip.

For example, if you have been taking medication for high-blood- pressure control (even if this keeps the blood pressure down), they won’t pay for medical care if you have a heart attack or any related cardio­vascular problem on a trip.

Ditto for diabetes-control medica­tion and related complications, etc.

One exception to the use of this exclusion policy is International SOS Assistance. Their air-evacuation ser­vice is provided without regard to preexisting conditions.

Other exceptions are the few com­panies (Access America, American Express, Carefree Travel Insurance and Travel Assure) that have mod­estly restrictive policy language.

Their texts state that if a pre­existing condition has been “con­trolled” — that is, the policy holder is “not exhibiting symptoms or requir­ing the adjustment of treatment or medication” within the previous 60 days — then the companies policies would cover a related problem that occurred during the trip.

If you have been taking medication or have been treated, or even seen a doctor, for any medical condition within the previous six months, make sure you get a policy that uses the “60 days controlled” language.

Even then, a change in the dosage of your medicine in the two months before your trip would void your coverage for a related problem.

Trip cancellation policies — lots of gaps in the fine print

Trip cancellation insurance is rel­atively inefficient; individual policies are written for small amounts and up to 50% commission is paid to the selling agency.

Some “with it” tour company (or credit card company) should consider providing trip cancellation coverage at low rates. It would be a great selling feature.

I understand that in Europe, trip cancellation coverage is required but is supplied at very low costs, equiv­alent to $5-$8.

Here in the States as many as 80% of travelers buy trip cancellation insurance and a “minuscule” number ever have to file a claim.

If you’d feel more comfortable with this coverage, look for the "controlled preexisting condition” phrase in the fine print. Access America Inter­national, Travel Guard, American Express and Travel Insurance PAK use this more-forgiving phrase in their trip cancellation policies.

This coverage is offered by the same companies that offer overseas health coverage. Use the toll-free numbers provided to ask about your destination. Lists of excluded coun­tries can be up to 60 destinations long and the lists change.

Ask how they interpret “terrorist- related” cancellations.

For example, if you were to cancel a trip to London because of some inci­dent, would it have to be a State- Department-recognized group that was responsible, before the company would pay?

How about a sudden epidemic of cholera in Peru?

What if the tour company defaults (instead of declaring bankruptcy), as in last year’s Hemphill Harris case where travelers were stranded in mid-trip?

Access America and World Care Travel Assistance have text that seems more generous than some of the others. Travel Guard Gold (the most expensive at 8%) claims, “If you cancel your trip for any reason. . . we’ll pay.” (Of course, there’s an asterisk and some more fine print.)

You may be pleasantly surprised to find out that your standard health insurance policy provides significant overseas coverage. Check with your employer or agent, mentioning your specific itinerary.

The August 1990 issue of Consumer Reports Travel Letter has a com­prehensive comparison of trip-inter­ruption policies. (Many public li­braries have copies.)

Credit cards

Major credit cards have been quietly adding interesting services.

Most have overseas “hot line” phone numbers for assistance and referrals and will advance emergency funds above your normal credit limit. Find the “800” number on your card’s literature and inquire about these services before a trip. 

Gold MasterCard, for example, has a comprehensive, no-extra-cost, overseas MasterAssist Medical Pro­tection program. They have a hot line for referrals to medical providers. They’ll pay up to $10,000 for trans­portation costs if the cardholder (or spouse) must be transferred home for medical care. Additionally, they pro­vide secondary medical coverage up to a maximum of $2,500 per person per trip for hospital or emergency care. 

MasterAssist Medical will pay $75 per day for five days of hotel con­valescence. They also will pay for a relative from home to come to your bedside if you’re hospitalized over­seas for more than eight days.

Grim note (but it can happen) — in the event of a death overseas, they will make arrangements and pay up to $10,000 for return of the deceased.

VISA Gold cardholders may have access to similar services, depending on the individually issuing banks; inquire before your trip.

American Express sells trip in­surance. Their cards offer medical referrals and other medical emergen­cy assistance.

Discover Card Private Issue provides medical referrals worldwide.

Diners Club has a comprehensive International Emergency Assist plan. The costs for care are the cardholder’s responsibility. Diners Club can, however, provide payment guarantees to hospitals based on confirmed benefits available from the cardholder’s private health insurer.

Bankcard Holders of America (560 Herndon Parkway, Ste. 120, Herndon, VA 22070) offers its members a va- - riety of information and brochures including the Gold Credit Card List that lists banks with attractive fee and/or interest-rate costs.

They also have a new brochure, “Choosing a Gold Credit Card: A Consumer Guide to Gold Card Fea­tures and Benefits.” Upgraded credit cards offer the most overseas assis­tance programs.

Annual membership in BankCard Holders of America is $18.

Standard Health Insurance

You may be pleasantly surprised to find out that your standard health insurance policy provides significant overseas coverage. Check with your employer or agent, mentioning your specific itinerary. (Medicare does not provide any coverage outside of North America.)

Blue Shield of California has a small brochure entitled “Passport" that gives all the appropriate over­seas coverage information. I stuff it into my travel document case before heading off.

Blue Cross and Blue Shield have a list of 182 hospitals in 52 countries that provide inpatient care for mem- | bers and then bill the “Blues” di­rectly. For this information, phone 800/522-2855 (in the District of Co­lumbia, phone 861-3800).

The “Blues” air-evac coverage is extremely limited; they may reim­burse modestly, based on some equiv­alent to ground ambulance rates. Confirm all details before a trip.

Kaiser Permanente has an “Emer­gency Services” brochure that briefly discusses overseas coverage. The bottom line is they reimburse on the same basis as for domestic coverage.

A representative I spoke to said that "medically air evacuation is covered,” but I’d strongly recommend checking on this and all other required reimbursement details.

Filing a claim for reimburse­ment

If you can keep your wits about you during a stressful time, try to re­member that you will have to collect a tidy package of receipts for your insurance company at home.

Everything MUST be in English and on business letterhead station­ery. Don’t leave without translations. If necessary, get to a U.S. Consulate office for assistance.

Provide as much detail as possible regarding diagnosis and also costs for hospital room, laboratory, anes­thesia, doctors, etc., and amounts paid (in U.S. dollars).

In case of an accident, write up a detailed description as soon as pos­sible. Police, emergency personnel and/or witnesses’ statements are useful. Don’t forget dates and loca­tions. (Most overseas health policies and credit card “assist” programs are prepared to help with these and many other problems that you never would have expected to crop up.)

Later on

If you experience unusual symp­toms, even long after your trip, be sure to tell your doctor the areas you have visited. It will help greatly in diagnosis and treatment.

For example, a very serious illness can develop 20 years after the bite of the “kissing bug” that lives in the Amazon Basin.

Overseas medical policy com­parisons

On page 29 is an abbreviated com­parison of overseas health insurance companies’ offerings. They have a variety of additional services (and fine-print conditions) that are not indicated here.

Make a selection only after com­paring brochures and asking a few questions that apply to your itinerary and health conditions.

Don’t ignore or be intimidated by the fine print — it’s the most im­portant part of the brochure.

Some companies don’t provide a full disclosure of exclusions until after you have signed and paid. Caveat emptor!

Have a worry-free trip

Sort through the information below and compare details of ser­vices available as they apply to your destination and other circumstances.

You should be able to decide how to take off with fewer worries to infringe upon the enjoyment of your trip.

After doing all this research, I’m going to be satisfied traveling over­seas with a Gold MasterCard and my Blue Shield “Passport” brochure for “security blankets.”

For the compulsive reader

I will send you additional informa­tion C/O ITN. 

Limit for Limit for Emergency Medical/Company Toll-free Address Evacuation Accident Cost
Access America International (3) 800/284-8300 P.O. Box 11188, Richmond, VA 23230 Unlimited $10,000


$49 for 9-15 days
American Express


800/234-0375 P.O. Box 2070,

San Rafael, CA 94912

$100,000 $5,000 $110 for 9-17 days (1)
Carefree Travel Insurance (3) 800/323-3149 P.O. Box 310, Mineola, NY 11501 $25,000 $5,000 $119 for 9-17 days (1)
Health Care Abroad 800/237-6615 '243 Church St. NW, Vienna, VA 22180 $100,000 $100,000


$45 for 15 days
International SOS Assistance 806/523-8930 P.O. Box 11568, Philadelphia, PA 19116 Unlimited (5) $35 for 1-14 days
Travel Assure


800/228-9792 P.O. Box 31685, Omaha, NE 68131 $25,000 $2,500


$45 for 9-15 days
Travel Assistance International 800/821-2828 1133 15th St. NW, Washington, D.C. 20005 Unlimited $5,000


$50 for 9-15 days
Travel Guard


800/782-5151 1100 CenterPoint Dr., Stevens Point, WI 54481 __ $15,000


$39 for 11-15 days
Trav Med 800/732-5309 P.O. Box 10623, Baltimore, MD 21204 $100,000 $100,000


$45 for 15 days
World Care Travel Assistance (4) 800/253-1877 1150 South Olive St., Los Angeles, CA 90099 Unlimited $10,000


$105 for 9-15 days (1)
Prepaid Air Rescue 800/338-4919 5000 Quorum Dr., Dallas, TX 75240 Unlimited __ $119 for one year
Travel Insurance PAR (3) 800/243-3174 1 Tower Square, Hartford, CT 06183 $25,000 $2,000 $60 for 11-18 days
(1) Includes trip cancellation. (2) Will pay bills directly to overseas medical care providers. (3) Uses preferred “controlled preexisting condition” language. (4) Now offering previously unavailable policies that cover terrorist and/or war-related hazards. (5) Medical insurance available through Travel Guard at extra cost.

See text of article for credit-card company health insurance coverage.