Covered in the hinterlands?

The article “Will I Have a Medical Emergency Overseas?,” back in the August 2011 “Eye on Travel Insurance” column, discussed the likelihood of travelers needing treatment plus the types of coverage one might want. One key thing I felt the article did not place enough importance on was where one is going, such as Antarctica, Madagascar or Svalbard in Norway, to name a few of the more remote destinations, as opposed to visiting places like the major European capitals on a tour. Among the issues are getting in contact with help, being moved to a facility that can handle the problem, dealing with the urgency involved, obtaining knowledgeable attention and, lastly, getting back home. I tend to go to off-the-beaten-trail locations, from some of which there are poor to no medical facilities for hundreds or thousands of miles around. In addition to taking considerable time to get to a health facility, contacting help can also be an issue in places with no cellular phones, satellite phones or shipboard radio. Circumstances vary. In many instances I travel alone, with no guide; sometimes I take a private tour with a guide, and at other times I am on a cruise with or without a doctor on board. Some countries make health services available to visitors for free or at minimal cost (England and Sweden come to mind). However, you still have to get to the hospital. All of this and more are considerations in whether or not to get insurance and what kind to get. For places that are very out of the way, I usually get an “umbrella” addition to my policy with Travel Guard (Stevens Point, WI; 800/826-4919 or 715/345-0505). It doubles the money they give for medical-evacuation transportation and for medical treatment. In April 2009 I was getting ready to leave for New Guinea when I suffered a minor stroke. I was in the hospital for three days and released four days before my scheduled flight. My doctor completed forms stating that he strongly advised me not to take the trip. Travel Guard* reimbursed me for everything: the cruise, air, hotels and visa. I did have everything documented. I had used frequent-flyer miles for the airfare, and Travel Guard paid the penalty for reinstating them, which I think was about $250. Now I usually choose Travel Guard, especially since that refund was processed so quickly — about two weeks after submitting a claim and answering some questions with paper backup. However, if I book a cruise with an agent, I may book the insurance offered through the agency because, once out in open waters, some rules change and the ship’s doctor has to get paid too. I believe that neither Medicare nor the supplement pays for anything on the ship.** JOYCE BRUCK Ocean Ridge, FL *Travel Guard told ITN that Ms. Bruck’s policy for her 2009 trip had a waiver for preexisting medical conditions. Unlike their basic policy, which can be purchased as late as 24 hours before the trip-departure date, her policy required that for any amount of nonrefundable trip arrangement costs that she prepaid and wanted to be covered, she had to make a corresponding payment for the Trip Cancellation coverage within 15 days. That is, if she paid for her whole trip in advance all at once, she had 15 days in which to pay the full amount of the insurance cost. But if she chose to prepay for her trip in installments, after each installment she would have 15 days to pay the cost of the insurance covering that additional amount. Ms. Bruck chose to prepay for the trip in one lump sum, followed by paying for her Trip Cancellation coverage within the two weeks. She wrote, “It may be more money, but, as I sometimes make reservations as much as one year in advance, locking in a policy with the waivers, the exposure time is lengthy.” **On board a ship, if you are provided with medical services while in US waters or within six hours of either departure or arrival at a US port, Medicare may pay for medically necessary treatment. If the ship’s doctor is based in the US, he submits the claim; if the doctor’s office is outside the US, the patient must obtain form CMS-14905 from Medicare and follow the directions on how and where to submit the claim. Lastly, ITN’s travel insurance expert, Wayne Wirtanen, reiterates, “If you are going to a remote destination or an area of spotty infrastructure, look for a travel insurance policy with high limits for both medical coverage and emergency medical evacuation coverage.”