Travel cover: the medical limit is the only number that matters

What follows is an argument about travel insurance, and about where the received version of it stops being true.

Compare medical, then ignore the rest

The realistic worst case on a trip is emergency treatment abroad followed by a medically-escorted flight home. That can run to six figures in some countries, which makes the medical limit the only figure worth optimising.

Baggage and cancellation limits are small by comparison and rarely decide whether a trip is financially survivable. A policy with a high medical limit and modest baggage cover is the right shape.

State health arrangements are not insurance

Reciprocal healthcare agreements cover state treatment in participating countries and nothing else. They do not pay for repatriation, private treatment, or bringing you home early, and repatriation is the expensive part. They are worth having alongside a policy and are no substitute for one.

They also depend on carrying whatever card or registration the scheme requires, on being treated inside the state system rather than at the private clinic an ambulance may default to, and on arrangements that shift as treaties change, so a scheme that applied on a previous trip is worth re-checking before the next one.

Disclosure decides medical claims

Conditions under investigation, recent changes in medication and consultations without a diagnosis usually all count as pre-existing. Insurers interpret this broadly and check medical records at a large claim.

Declaring raises the premium modestly; not declaring can void the medical section entirely. The duty does not stop at purchase either, since most wordings require any change in health between buying the policy and travelling to be reported, and a diagnosis arriving in that window is exactly the one people assume must be covered because the policy was already in force.

Activities and transport are commonly excluded

Winter sports, diving, climbing and anything motorised are frequently excluded or need an add-on. Riding a scooter without the correct licence category is a specific and very common exclusion. Check the activity list against what you will actually do, including anything you might be talked into.

Two conditions cut across the entire list: cover is commonly excluded where alcohol or drugs contributed to the incident, and where an activity carries a safety requirement — a helmet, a licence, an instructor, a diving buddy — the wording often makes that a condition of cover rather than a recommendation.

The assistance line is the real product

A twenty-four hour emergency line that arranges and guarantees payment directly to a hospital is worth more than a higher headline limit. Policies that only reimburse you afterwards require you to fund treatment upfront, which in some countries is not feasible. Check which model your policy uses before you need it.

The corollary is to contact that line before agreeing to treatment wherever the situation allows, since many wordings require prior authorisation for anything not immediately life-threatening and will decline private treatment arranged without it — which also means the number needs saving somewhere reachable without a working phone or a data connection.

Cancellation pays for listed reasons, not for changed minds

Cancellation cover responds to a defined list of causes — illness, injury, bereavement, jury service, redundancy in some wordings — and not to a decision that the trip is no longer wanted, which is exactly the gap that cancel-for-any-reason upgrades are sold into. Where an airline cancels a flight or a tour operator fails, the first recourse is usually the airline, the package travel rules of the country you booked in, or the card you paid with, and most policies specifically exclude anything another party is legally obliged to refund.

That ordering matters at the claim, because an insurer will normally ask what the airline, the operator and the card provider have paid before it considers the balance. Official advice against travel to a destination switches cover off in many wordings rather than triggering a payout, which is the reverse of what most travellers expect and is worth reading before it becomes relevant.

The takeaway

Sort by medical limit, declare everything, and check the assistance line pays hospitals directly.

The version you keep doing is the version that works.