When my father‑in‑law, Jim, collapsed in a hotel room in Tallinn, Estonia, his wife Carole had him rushed to the East Central Tallinn Hospital. He was placed in intensive care, heavily sedated, and had an oxygen tube shoved down his throat. For two days, his illness was a mystery to the local doctors, until they finally diagnosed him with Legionnaire’s Disease, the first case that they had ever seen at the hospital. He had apparently contracted it a week earlier in a hotel in Belarus.
Jim was not only given a dire prognosis. He was stuck in a hospital thousands of miles from his home in Door County, Wisconsin, a hospital where English was poorly understood, the hygiene dire and the treatment strikingly passive, a hangover from the Soviet era.
But he did have a travel insurance policy for his five week trip through the Baltics, and it included $500,000 of coverage for emergency evacuation. So Carole demanded that the insurer fly them home on a medical evacuation flight, a veritable air ambulance, with a doctor or nurse on board.
But this “emergency evacuation” coverage, which turns up in many travel insurance policies, would only cover transportation from where he had fallen ill to the nearest, best medical facility. Jim had collapsed in a hotel in Tallinn and they had gotten him into the East Central Tallinn Hospital, about a mile away. That, according to the insurer, was the nearest, best facility. A “repatriation” clause in the policy stated that the insurance company would pay for two economy class tickets home, seeing as how Jim and Carole would overstay their original return date. But with Jim unconscious, attached to a respirator and hooked up to a drip, it was pointless.
And as for a medical flight home, that wasn’t covered. Carole was quoted anywhere from $65,000 to $85,000 by medical evacuation companies and told that she would need to pay in full before the flight would even take off. Stunned, they sat it out, and Jim spent a month staring at the walls of the dreary East Central Tallinn Hospital before he was well enough to fly home commercially. Now they’re wrangling with the insurance company over picking up some of Carole’s month long hotel stay, meals, cell phone bills and other expenses.
In a world of scary stories, this one hits the heart and the wallet. No one wants to be stuck in a foreign hospital, away from family, friends and an English-speaking doctor, with medical personnel of questionable background who have never encountered your condition before. Nor does anyone want to take the financial hit that a medical evacuation flight costs. A domestic medical evacuation runs $20,000 and up. Flights from major European capitals are $65,000 and more. From remote corners of Asia, such as Mongolia, you’re looking at $120,000. The solution: purchase a medical evacuation membership before you leave home.
TERMS OF EVACUATION
Medical evacuation coverage is not travel insurance. In fact, it’s not insurance at all. It’s a “membership,” not a “policy”, and sold separately by a handful of companies like Global Rescue, Medjet Assist and International SOS.
That membership entitles you to a medical evacuation, which means that you will be transported on a medical flight from a hospital that’s typically at least 100 miles or so away from your home to the hospital of your choice via a private air ambulance. At its most basic, it covers the cost of transporting you in an ambulance to the aircraft, the flight, and then on to another ambulance to the home hospital.
“We are strictly the transportation component,” says Roy Berger, president of MedjetAssist. “We are akin to AAA. We are the tow truck that comes to get you up and going. But the repairs come out of your own pocket.”
WHY YOU NEED IT
If you’re into adventure travel, a business traveler or simply on vacation, accidents can happen. You could be on a bike trip in France, a trek in Tibet or driving down the road in Argentina. But since 60 percent of all claims at a medical evacuation provider like MedjetAssist are domestic, factor in a heart attack in San Francisco or a car accident in Dallas as reasons why you should consider it.
WHAT TO LOOK FOR
The key phrase to look for in any company’s literature is “a flight to the hospital of your choice.” A true medical evacuation membership delivers this.
Most travel insurance policies claim to have it — indeed, reservationists will blithely tout it — but they don’t. What they’re selling you is transportation from where you fall ill to the nearest, best medical facility. When you’re better, they will repatriate you on a commercial flight, sometimes with a nurse escort if necessary. In other words, it’s virtually identical to what my father‑in‑law’s coverage offered. But that’s not a medical evacuation to a hospital of your choice.
As for your American Express Platinum Card, long praised for its merits in this kind of situation? Well, if you’ve had an accident on safari for example, you can call the Amex hotline and they can coordinate an aircraft to get you out of the jungle and into a hospital in Nairobi. But it will not cover the cost of any of this, much less the medical flight from Nairobi back to your hospital in New York City, Shaker Heights or San Diego.
WHAT IS THE FLIGHT LIKE?
The aircraft is typically a small corporate jet outfitted as an airborne Intensive Care Unit, with a doctor, a nurse, or EMT onboard, as well as a pilot and co pilot.
“We primarily use Lear Jets,” says Roy Berger of MedjetAssist. “These are flying ICU’s, not a posh corporate jet. They are not comfortable if you don’t have to be on one and if push comes to shove, you never want to see one.”
WHO MAKES THE DECISION TO FLY?
“A medical evacuation is obviously based on the condition of patient,” says Tim Daniel, VP of sales and marketing for InternationalSOS, which handled 16,010 medical evacuations in 2007. “We won’t repatriate someone unless they’re medically stabilized.”
Most companies, like MedjetAssist, do a triage involving the attending physician, your physician at home and the MedjetAssist doctor, who is affiliated with the University of Pittsburgh Medical Center.
In many cases, if an attending physician thinks you could be released within a few days, the evacuation company will help you fly commercially instead. And you’ll get a business or first class flight, accompanied by medical personnel if necessary.
WHAT IT COSTS
Individual costs start at around $85 for a seven‑day individual membership and run $225 and up for an annual membership. Most companies offer family memberships as well.
WHAT ELSE DOES IT COVER
In most cases, nothing. A medical evacuation policy covers none of your medical expenses, such as a hospital stay, emergency room charges, doctor visits or medication. You’re responsible for those, either via your own medical insurance, a travel medical insurance (TMI) policy or your own pocket.
WHAT ELSE DOES IT OFFER?
International SOS, which is widely used by expats around the globe, has 26 “alarms centers,” clinics that you can use when you’re on the road. In many cases, these take the place of a local, less than savory hospital. Most companies have 24 hour support and can put a translator on the line to speak to a doctor in his own language. And every medical evacuation membership has higher levels of membership, for more money, of course. Some of their perks can be useful, from storing your medical records securely on line to providing a cash advance for a medical emergency.
DO I STILL NEED TRAVEL INSURANCE?
Yes, because it’s the “emergency evacuation” component of a travel insurance policy that can get you the local hospital in the first place. As they did with my father-in-law.That’s obviously critical, and such transport is not covered by most medical evacuation companies, such as MedjetAssist, which only kicks in when you’re already an inpatient. And travel insurance covers a host of other potential problems, from trip cancellation to trip delay and interruption. It typically covers baggage loss and includes accident and sickness insurance as well as flight insurance. The amounts of coverage vary with each policy and most travel insurance is sold on a per trip basis. You take out travel insurance to avoid losing a bundle on trips that you’ve pre‑paid, such as a biking trip to France or a cruise to Asia. And at a time when delays and flight cancellations are endemic, it’s not a bad idea to have it.
ANY FINE PRINT?
If you’re an adrenaline junkie, these companies won’t get you out of a war zone. And they often can’t go into disaster zones. For example, most were barred by the US Government from entering the area where Hurricane Katrina struck. You’re usually restricted to trips of 90 days or less and most have a limit on how many times you can be rescued a year, usually twice. Some have a pre-existing condition clause for travelers over the age of 70. But that’s usually it. So for the price of a cheap airline ticket, you’ll be flown home wherever you happen to fall ill.
MEDJET ASSIST (www.medjetassist.com)
GLOBAL RESCUE (https://www.globalrescue.com/)
INTERNATIONAL SOS (www.internationalsos.com)