Travel health without overpaying

Falling ill abroad is one of the few situations where a household can face a genuinely catastrophic bill, and the preparation that prevents it costs very little.

Travel insurance

Where the terms determine everything.

The medical section is the part that matters, and the headline price rarely reflects it.

What to check: the medical expenses limit, which should be substantial; whether repatriation and medical evacuation are covered, which is the item that produces the largest bills; the excess; and the exclusions.

Repatriation by air ambulance costs an amount most households could not meet, which is the entire reason for buying insurance rather than self-insuring.

Pre-existing conditions

The most common reason claims are refused.

Almost all policies require disclosure of pre-existing medical conditions, and definitions are broad — frequently including anything investigated, treated or medicated within a stated period, and sometimes anything you are awaiting results for.

Non-disclosure invalidates the policy, generally for the whole claim rather than only the related part.

Declaring conditions raises the premium and is the only way the cover works.

Specialist insurers exist for people with significant medical histories, and their prices are frequently better than mainstream insurers loading a policy.

And a change in medication or a new referral between buying the policy and travelling generally needs declaring, which people rarely realise.

The other common exclusions

Worth reading before assuming.

Alcohol and drug-related incidents, which is a broad exclusion and one insurers apply.

Hazardous activities, where skiing, diving, climbing, motorcycling and even some organised excursions require additional cover.

Travel against official advice for a destination.

Travel against medical advice.

Pregnancy beyond a stated gestation.

Claims arising from failure to take reasonable care.

And undeclared trips outside the stated geographical region.

Reciprocal healthcare arrangements

Which help and do not replace insurance.

Some countries have reciprocal agreements entitling visitors to state healthcare on the same basis as residents, which may still involve charges.

These do not cover repatriation, do not cover private facilities, and do not cover treatment that would not be provided to a resident.

Which means they reduce costs rather than removing the need for insurance.

Where such arrangements exist, obtaining the relevant card or documentation is free and worth doing.

Vaccination and prophylaxis

Where costs vary considerably.

Some travel vaccines are provided free under national programmes and others are charged privately, and the split differs by country.

Checking which are free before booking a private travel clinic can save a substantial amount.

Some vaccines require courses over weeks, which means seeking advice six to eight weeks before travel.

Malaria prophylaxis costs vary between agents and between pharmacies, and bite avoidance is the primary measure regardless.

Yellow fever vaccination is required for entry to some countries and is only available at designated centres.

Taking medication abroad

Where problems arise at borders.

Carry medicines in original labelled packaging with a copy of the prescription.

Split supplies between hand luggage and hold luggage where possible, and keep essential medication in hand luggage.

Check the legal status of your medication at the destination, since drugs that are routine in one country are controlled or prohibited in others — this genuinely results in detention.

Controlled drugs may require a licence for travel.

Take more than you need, allowing for delays.

And consider time zone adjustments for timed medications, particularly insulin, which warrants specific advice.

While you are there

Practical.

Know how to contact your insurer's emergency assistance line, and contact them before treatment where possible, since many policies require authorisation.

Keep all receipts, reports and documentation, since claims fail on evidence.

Use state facilities where reciprocal arrangements apply.

Be aware that private clinics in tourist areas in some countries have been the subject of complaints about over-treatment and inflated billing.

And for minor illness, pharmacies abroad frequently have wider dispensing powers and are the cheapest route.

Medical tourism

A separate consideration.

Travelling deliberately for treatment can be substantially cheaper, and carries specific risks: regulation and standards vary, follow-up and remedial treatment are difficult at a distance, complications may arise after returning, and standard travel insurance generally excludes planned treatment entirely.

Some procedures require a period before flying because of thrombosis risk.

And anyone considering it should establish in advance who will manage complications at home, which is the question that determines whether the saving is real.

General information only, not medical, insurance or legal advice. Read policy terms carefully, declare all medical conditions, and consult a travel health service well before travelling.