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'Extreme' travel insurance not just for adventure junkies

If you were among the hundreds of American tourists who've been trapped in politically volatile Egypt, how would you get out? Some Americans have relied on a type of insurance that can extract a bewildered traveler from a politically unstable country like Egypt or pluck an injured climber off a snow-covered mountain in South America.

New Hampshire-based On Call International just evacuated 65 of its American customers -- students, business travelers and vacationers -- from Egypt to Greece and the Czech Republic. Those evacuees eventually will wind up back in the United States. On Call International provided similar services to more than 25 U.S. and Australian citizens who were in Mumbai, India, during a series of deadly terrorist attacks in 2008.

Actually, coverage like what's offered by On Call International isn't insurance. Rather, it's a membership plan. Whatever it's called, some travelers swear by it, particularly since it's relatively cheap.

Some of these membership plans -- such as Air Ambulance Card and MedJet Assist, both of Birmingham, Ala. -- provide members with medical evacuation to either a hometown hospital or any hospital of their choice if they need care than 150 miles from where they live. Both companies boast a network of health care providers as well as medically equipped jets and aircraft carriers.

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“Typical travel insurance is based on medical necessity to the nearest appropriate facility, and the insurance company makes all the decisions. In our case, it’s your decision if you want to go back home,” says Stan Bradley, managing partner at Air Ambulance Card.

Byron Vickery, a malpractice attorney in Ohio, didn’t require emergency evacuation back to the United States, but he did require emergency gallbladder surgery while he was visiting his daughter at the University of St. Andrews in Scotland. The surgery left him with a 10-inch incision and in extreme discomfort. At his request, Vickery's MedJet Assist membership provided a surgical nurse escort and first-class air transportation for his trip back to the States.

“The nurse was a take-charge-type individual and made my transfer from Scotland to my hometown of Columbus, Ohio, as comfortable and safe as possible,” says Vickery, who remains an avid international traveler.

An emergency lifeline

Along with medical evacuation, Singapore-based International SOS maintains 31 of its own health clinics in developing nations, such as Azerbaijan, Mongolia and Uganda. Members can visit these clinics for Western-style care. Other services include translation services and legal advice.

For serious illness and injury, International SOS has established a network of 70,000 health care providers around the globe. U.S. members needing assistance are served by a call center in Philadelphia, one of 25 such centers worldwide.

“Most consumers, myself included, are spending time on the Internet looking up to see what the best restaurants to go to, where can I get the best deal on a hotel. You could spend a couple of hours on that,” says Suzanne Garber, International SOS' chief operating officer for the Americas. “You might want to do the same for medical preparation as well.”

During a vacation with his wife to the French-speaking island of St. Maarten in May 2007, Philadelphia businessman John Friel suffered internal bleeding that led to heart failure, pulmonary edema and pneumonia. Fortunately, he had a membership with International SOS through his employer’s corporate plan.

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The Friels didn’t speak French; they had no idea where to go. A phone call to International SOS helped them locate the nearest company-recommended medical facility. After being flown from St. Maarten's Medical Center to Hospital Martinique, International SOS’ team of doctors and Friel’s American cardiologist determined that the only way to ensure Friel’s survival was to take him to the University of Pennsylvania Medical Center.

“I would be dead had International SOS not flown me from the Caribbean,” says Friel, who's now retired. “I tell all my friends, acquaintances and anyone else I meet that they are foolish if they do not sign up.”

'Nobody is left behind'

Along with standard medical evacuation, companies such International SOS and Boston-based Global Rescue offer something akin to a SWAT team.

“Whether it’s in Beijing or Kuala Lumpur or at the top of Mount Everest or even in a firefight somewhere, we’re Johnny on the spot,” says Stu Richards, vice president of Global Rescue. “No insurance company can help you at the top of Mount Everest or in a firefight.”

During the devastating 2010 earthquake in Haiti, International SOS and Global Rescue dispatched teams to locate and evacuate their customers, including corporate clients, missionary groups and educators.

"Our motto is, 'Nobody is left behind.' We’ll send people to get you help whether by raft or aircraft,” Richards says. “We have an exclusion that says if we think it’s too dangerous, we won’t go. But we’ve never been asked to go somewhere we’ve been unwilling to go.”

Numerous sports organizations and extreme adventure groups maintain corporate plans through companies like International SOS and Global Rescue.

Ben Clark, an executive producer of "extreme skiing" videos, had access to Global Rescue membership through his affiliation with the American Alpine Club, broke his ankle in May 2010 while walking along the Baruntse base camp in the Himalayas at 17,600 feet. Not only was the high altitude a problem, but at the time there was a labor strike in Kathmandu, Nepal, so vehicles weren't allowed on the roads. Global Rescue sent a rescue helicopter to fetch Clark.

“I’ve been running around mountains professionally for over a decade and nothing else comes close to this level of service and commitment that works out in minutes, not days,” says Clark, who captured the rescue on his blog.

Assistance in familiar and foreign lands

Even if you're not venturing to an exotic place like Nepal, membership in one of these plans can come in handy. At Air Ambulance Card, transfers within the United States have represented about half of the company's medical evacuations in the past five years. At MedJet Assist, though, 90 percent of members buy coverage for big international excursions, says John Gobbels, the company's chief operating officer.

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“They take their big trip to Africa and then come back fine. Then they go to the beach for a week and have some type of event or get really ill and they want to get back home as well," Gobbels says.

He adds: “We have no exclusions for adventure travel. A lot of our members are in the jungles, doing zip-lining or things where you could fall and have orthopedic injuries. We have an older population who is predisposed to heart disease and stroke. So it’s anything a member could have that places them in a hospital scenario."

Typically, medical evacuation plans even cover the cost of an additional passenger to accompany you. They also pay for transportation of your remains back home if you die.

These membership plans don’t cover actual medical expenses, such as treatment at a hospital -- things that your health insurance policy may or may not cover. International SOS does offer medical insurance for an extra charge, however. These plans also don't cover travel interruption costs -- such as hotel or luggage fees -- in the event of an evacuation.

Furthermore, some plans have age restrictions. For instance, Air Ambulance Card caps coverage at age 75. At Global Rescue, the age limit is 85.

The costs and the benefits

So what do these "extreme travel" services cost? Not as much as you think. Unlike traditional travel insurance, there are no bills, claim forms, co-pays or deductibles. The plans could spare you from out-of-network costs if you’re hospitalized away from home as well.

At On Call International, for example, a one-trip membership costs $55. For an annual membership, the price tag jumps to $225. These plans also sell memberships to Americans studying abroad or Americans living and working abroad.

For some people, that's a small price to pay, given the fact that a recent medical transport from the Philippines to the United States ran up $173,000 in costs for Air Ambulance Card. At Global Rescue, an evacuation from China totaled $200,000.

MedJet Assist's Gobbels says: “Most people don’t have that kind of money, so they end up having to stay in a foreign country until they can recuperate enough to be able to take a commercial flight back home. This membership, while it can certainly save your life, it can also certainly save your life savings."

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