Planning for an assignment abroad requires the coordination of many details, including housing, transportation, and required paperwork. Surprisingly, one of the equally important but sometimes overlooked items on this list is health insurance.
The simple fact is that many international travelers do not have appropriate insurance protection. Employer-sponsored plans often limit overseas coverage to emergency care only (and what you consider an emergency may be viewed differently by your home insurance company). Emergency medical evacuation is almost never covered. Even individuals traveling on short-term business trips will find they are subject to significant gaps in coverage.
Insurance is critical for international travel because obtaining health care in some parts of the world can be tricky. Some hospitals will not provide any treatment—or will not allow a patient to be discharged—until the hospital has received a guarantee of payment. Such guarantees commonly are provided by travel insurers in conjunction with assistance providers, but rarely by other insurers or managed care plans. This means you will have to pay in advance, perhaps as much as tens of thousands of dollars, with your credit card—if the hospital accepts foreign credit cards and your card has a sufficient credit limit.
In addition, remember that leaving your destination for a place with higher quality medical care, or to return home where your regular insurance is accepted, can be difficult. Medical evacuations can be complex and risky and you want to ensure you are in the hands of a reputable company. Worse, local authorities may have ties to certain evacuation companies.
Most travel insurance includes a medical assistance benefit, which is critical. It gives you 24/7/365 access to a company that will arrange an evacuation for you with a credible evacuation company—or, through their medical personnel, can help assure that you are receiving appropriate treatment locally. The assistance company also will be available to help with other travel-related problems such as legal troubles, lost passports, or stolen credit cards. Emergencies are rare but everyone should have a contingency plan.
Major Types of Insurance Coverage
As you prepare for your assignment, one of the first things you should do is assess your personal health plan. If you have health insurance in the United States, check with your insurance company and establish what type of coverage you have. If you have difficulty getting a straight answer, that alone should
be a warning. If you do not have insurance in the United States, consider that you might need it more than ever when traveling—and recognize that the coverage can be inexpensive—as little as $1.50 to $4.00 per day.
There are the three major types of coverage to consider. Most travel insurance products offer all three or two of the three:
- Health/accident insurance. Sometimes referred to as international health insurance, these policies pay for doctor and hospital bills, and sometimes dental care and medications. These plans can be written for short trips (one day to six months) and will supplement a managed care plan. International health insurance also can be purchased as primary insurance for someone relocating to another country for an extended period of time (six months or longer). Some of the plans available are comprehensive and include added features such as preventative services, acupuncture, chiropractic, maternity benefits, and more.
- Medical evacuation only. Evacuations can be expensive (as much as $50,000 or more from a remote location). In addition to the coverage, you will want assistance arranging an evacuation.
- Trip cancellation or interruption. This type of coverage protects you financially in the event you have to cancel or interrupt your trip for medical or other reasons. For example, say you purchase a $5,000 cruise but cannot take it because of personal illness—or illness in the family. Depending on when you cancel, a significant portion of the $5,000 may be non-refundable. This type of insurance will reimburse you. Ob-viously, this protection is unnecessary for business travel.
One form of travel insurance commonly sold at airports is “flight accident insurance,” which generally pays a lump-sum dollar amount in the event of death from a plane crash, an extremely rare event. If you are looking at insurance in an airport, make sure it also includes one or more of the three important coverages listed above.
Determining Coverage
Following is a list of things you should consider when determining what health plan is best for you:
Multi-trip vs. single trip plans. Some plans cover a single trip and others cover all the trips you take during a year. These multi-trip plans generally will put a limit on the duration of coverage during any one trip (usually about 30 to 70 days). If your trip exceeds that, you will not be covered at all, or will not be covered after the threshold day passes. Thus, these plans are not appropriate for extended travel, international study, or work abroad.
Group plans are available. If you are traveling on business, there are probably others in your company who also travel internationally. If your company has foreign employees, they may travel to the United States on occasion for training and other purposes. Your company can buy group coverage for both of these situations.
Primary vs. secondary coverage. Decide whether you need primary or secondary coverage. In the event of a medical claim or problem, primary coverage generally applies and pays the claim. Secondary coverage sometimes requires that you first go to your primary plan (for example, Blue Cross) and request payment. If you have good primary health insurance, secondary coverage probably is adequate for most travel (and it should be less expensive). Some secondary plans “pay as primary” for the traveler’s convenience, and then coordinate benefits with the primary plan.
Pre-existing conditions exclusion. Many travel plans exclude pre-existing medical conditions (so-called primary plans are more likely to do so—see the preceding). This means that medical conditions you have now or have had in the past (the definitions vary) are not included in your coverage.
Other exclusions. Many policies will not cover accidents and injuries related to certain sports and activities viewed as high risk, such as skydiving. Even skiing and scuba diving coverage may be limited or require a higher premium. Many policies also exclude mental illness, and they will not cover you if you are traveling against the advice of a doctor or traveling for the purpose of seeking medical care. Read the policy to make sure it has the coverage you need.
Deductibles and co-insurance. Like traditional medical insurance (that is, prior to HMOs), many travel insurance policies include deductibles and co-insurance. A deductible is the fixed dollar amount you must pay before the insurance provides any reimbursement.
Co-insurance is the percentage of the covered amount that you must pay. For example, if you purchase a plan with a $500 deductible and 20 percent co-insurance, then later submit a $1,000 claim for a covered service, you pay the first $500 (the deductible) and 20 percent ($100) of the second $500. The insurance will pay $400.
Safety Does Not End With Insurance
Whereas insurance provides a certain amount of financial security, it is not enough. Think about it in these terms: your homeowners’ policy protects you from financial loss, but that is only partial consolation if your house burns down.
That is why your town has a fire department, why you install smoke detectors, and why you are careful not to leave candles burning unattended.
The same concept applies to travel insurance. Secure the insurance, but make sure you take other steps to prevent illness and injury when traveling such as getting appropriate vaccinations; following other precautions necessary for your destination, such as food and water warnings; learning something about the health care that is available in your destination, such as the names of preferred hospitals and the local emergency numbers (911 does not work in every country); obtaining the names of qualified, English-speaking doctors and other medical providers in your destination (the right diagnosis is usually the cheapest); learning whether ambulances can be trusted to transport you in the event of emergencies (in some places, it is safer and faster to take a cab.); learning about pharmacies in your destination—are they reliable and open at night (If you take medication regularly pack two supplies and place one in your carry-on luggage.); traveling with a first-aid kit; and bringing copies of key portions of your medical records—your EKG, for example.
A little preparation goes a long way in protecting business trips and assisting the business travelers.
Frank Gillingham, M.D., is medical director and has led HTH Worldwide’s, Radnor, Pennsylvania, international business development efforts in Europe and Canada. He is a board-certified internist and emergency medicine specialist and is a private emergency physician in Southern California. Dr. Gillingham can be reached via the HTH website at www.hthworldwide.com, +1 610 254 8700, or e-mail fgillingham@hthworldwide.com.