Medical And Dental Expense Coverage


This benefit is included in almost all package plans and is intended to reimburse you for expenses related to illnesses or injuries that first occur after beginning your trip. Here's one example:

ACCIDENT & SICKNESS MEDICAL EXPENSE

For the purpose of this benefit:

"Covered Expense" means expense incurred for services and supplies: (a) listed below; and (b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment; which is limited to:

1. The services of a Legally Qualified Physician;
2. Hospital or ambulatory medical-surgical center services (this will also include expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery of a Sickness or Injury);
3. Transportation furnished by a professional ambulance company to and/or from a Hospital; and prescribed drugs, prosthetics and therapeutic services and supplies.

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount, if You incur a Covered Expense as a result of a Sickness that first manifests itself during the Trip or Injury that occurs during the Trip.

Only Covered Expenses incurred within the 52 weeks following the date of the Sickness or Injury will be reimbursed. Expenses incurred after the 52 weeks following the date of the Sickness or Injury are not covered.

Benefits will include expenses incurred during the Trip for emergency dental treatment due to Injury not to exceed $750. Expenses for emergency dental treatment incurred after the Trip are not covered. Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount [in this example it's $100,000], if needed, to secure Your admission to a Hospital, because of a covered Sickness or Injury. The Program Medical Advisor will coordinate advance payment to the Hospital.



Most of the above is fairly standard across the insurers out there. The maximum benefit amount typically ranges from $10,000 to $100, 000 although some plans can top $1,000,000 or more.

The medical expense benefit is one of those that, depending on the plan, can offer "primary" or "secondary" coverage. Read here for a more thorough discussion of that topic.

The maximum benefit is, of course, important -- more is usually better, But there's a couple of other features here that are important to consider. First, note that the plan will continue to pay your bills up to a year after you get home. That can make a big difference to your wallet. For example, say you were injured on your trip and after you get home will need several months of continuing medical care. The cost of your care will now probably be borne by your regular health insurance and you'll probably end up having to cover some co-payment or deductibles. With this plan, whatever your regular health insurance plan won't pay can be submitted to the travel insurer for reimbursement for up to one year or until you reach the benefit limit.

The last portion of that definition is also very important and a feature some plans do not provide. There are many parts of the world where the local hospitals require a substantial pre-payment (often up to $10,000) before you can be admitted. If you can't come up with that you can be denied service. With tis benefit your hospital admission can be guaranteed. Also, your travel insurer probably expects you to cover the hospital bill yourself and submit it for reimbursement when you get home. This plan, in some circumstances can arrange direct payment for you. A very nice feature.

Most travel-related medical situations are what you'd expect -- bad sunburns, tummy upset, a sprained ankle, or a cut finger requiring a few stitches. CSA has addressed this with their "no out-of-pocket" medical referral program.  Here's their description of this feature:


If you need medical assistance while traveling or en route to trip departure, you can call CSA's 24-hour assistance hotline to get a referral within the CSA designated provider network of 30,000 physicians and 180,000 service providers worldwide. Then when you receive treatment, you simply acknowledge that you received the one-time care, which must be under $1,000, and the physician or service provider will submit paperwork to be reimbursed directly from CSA. This allows you to receive treatment without spending your vacation dollars when the unexpected occurs. If the medical expense is more than $1,000 the standard claims process would be in place.

Coverage for dental emergencies is usually pretty limited. Here's one example:

Benefits will include expenses incurred during the Trip for emergency dental treatment due to Injury not to exceed $750. Expenses for emergency dental treatment incurred after the Trip are not covered.


Note that only injuries are covered -- not normal maintenance of your dental health. Need an emergency root canal during your stay in Paris? Not covered. Replace a lost filling or fix a loose crown? Not covered. Fall down and crack a molar? Covered.

If you do need medical or dental assistance during your trip don't forget to call the insurer's 24-hour assistance phone center. They can locate an English speaking doctor or dentist just about anywhere and direct you to the proper help. They also usually have medical professionals on staff to answer questions.


travel insurance basics