Which travel insurance to choose

General information for travellers, not insurance or medical advice. Policies, legal requirements and health entitlements differ by country of residence and destination. Read the policy wording of any product before buying it.

Most people buy travel insurance for lost luggage and cancelled flights. Those are the smallest part of what it does. The reason it exists is a single scenario: you are seriously injured or ill in a country whose healthcare you have to pay for, and you need to be treated, stabilised and flown home.

That is a bill that can run into six figures. Everything else in the policy is secondary.

What a policy actually covers

• Emergency medical treatment abroad - hospital, surgery, ambulance, medication.
• Repatriation and medical evacuation - being flown home, sometimes with a medical escort, sometimes on a stretcher occupying several seats. This is the expensive part and the reason to have cover at all.
• Cancellation and curtailment - the money you have already spent when you cannot go, or have to come home early, for a covered reason.
• Missed departure and travel delay - costs when you miss a connection or wait an extended period.
• Baggage and personal possessions - usually with a low per-item limit and a large excess.
• Personal liability - if you injure someone or damage property. Underrated and occasionally very important.
• Legal expenses, on some policies.

The exclusions that catch people out

Claims are refused far more often for these than for anything else. Read this list against your actual plans.

• Undeclared pre-existing medical conditions. The single biggest cause of refused claims. Declare everything, even things you consider resolved. A higher premium is cheaper than an unpaid hospital bill.
• Alcohol. Many policies exclude anything that happens while intoxicated, and the threshold is not always defined generously.
• Motorbikes and scooters. Frequently excluded entirely, or covered only if you hold the correct licence category at home and wear a helmet. Renting a scooter on an island is the classic uninsured injury.
• Altitude limits. Standard policies often cap trekking at 2,000 to 3,000 metres. Everest Base Camp, the Inca Trail, Kilimanjaro and the Pamir Highway all exceed common limits.
• "Adventure activities." Diving, climbing, skiing off-piste, bungee, paragliding, whitewater - each usually needs a named add-on.
• Unattended possessions. A bag left on a beach or a café chair is not covered, and neither, generally, is anything left in a vehicle.
• Loss without a police report. Most policies require one within 24 hours.
• Travelling against official advice. If your government advises against travel to a region, cover is typically void there.
• Known events. A storm already named, a strike already announced, an outbreak already declared - you cannot insure against something that has already started.
• Working. Many leisure policies exclude any paid work, including casual and volunteer arrangements.

How much medical cover do you need?

Ignore headline figures like "£10 million" - they are marketing. What matters is that the policy covers repatriation without a sub-limit that is far lower than the headline.

Rough guidance by destination:

• United States and Canada: the highest cover you can get. Medical costs there are the reason premiums for those destinations are two or three times higher.
• Remote regions - high mountains, deserts, small islands, polar areas: check that search, rescue and evacuation are covered specifically, not just treatment once you reach a hospital. Helicopter rescue is often a separate line.
• Most of Europe, Japan, Australia, New Zealand: standard cover is generally adequate, but see below on reciprocal agreements.

Reciprocal healthcare is not insurance

Some countries have agreements giving each other's residents access to state healthcare - the European Health Insurance Card and its UK equivalent being the best known. These are genuinely useful and free to obtain, and you should have one if you are eligible.

They are not a substitute for insurance. They do not cover repatriation, they do not cover private treatment, they do not cover cancellation or belongings, and they only apply in participating countries. Carry both.

Single trip, annual, or long-stay?

• Single trip: cheapest for one holiday a year. Cover applies for those dates only.
• Annual multi-trip: usually pays for itself at two or three trips. Watch the maximum trip length - commonly 30 or 45 days per trip - and whether your home country is included for domestic trips.
• Long-stay or backpacker: designed for months away, often with the option to extend from abroad and to return home briefly without voiding cover.
• Nomad and expatriate policies: a different product, for people living abroad rather than travelling. If you are away for a year, this is probably what you need.

One trap worth naming: most annual policies require you to start your journey from your home country. If you are already abroad when you buy, many insurers will not cover you at all, and the ones that will charge more.

Card-included insurance: check before relying on it

Premium credit cards frequently include travel cover, and it can be genuinely good. It also commonly requires that you paid for the trip with that card, caps trip length at 30 or 60 days, excludes travellers over a certain age, and has lower medical limits than a standalone policy.

Read the actual policy document, not the marketing page. If it fits your trip, you have saved money. If it does not, you have discovered that in advance, which is the point.

Buy it when you book, not before you fly

Cancellation cover starts the day you buy the policy, not the day you travel. Buying insurance the week before departure means the months between booking and going were uninsured - and that is exactly the period when the illness, injury or family emergency that stops you travelling is likely to occur.

Buy the policy on the same day you pay the first significant deposit.

How to compare policies honestly

1. Write down what you will actually do: the countries, the maximum altitude, any activity with a licence or a helmet, the total prepaid cost of the trip.
2. Filter for policies covering all of it, then compare price.
3. Check the excess per claim - a cheap policy with a high excess is not cheap for a small claim.
4. Check per-item and per-category limits, especially for a laptop or camera. Valuable single items usually need to be named.
5. Check there is a 24-hour emergency assistance line and save the number offline.
6. Read the exclusions section in full. It is two pages and it is the only part that matters when something happens.

If something goes wrong

• Call the emergency line before treatment where you can. Many policies require pre-authorisation for anything non-trivial, and the assistance company will often pay the hospital directly.
• Keep every receipt, report and discharge document. Photograph them immediately.
• Get a police report within 24 hours for theft or loss, and a written report from the airline for baggage.
• Do not agree to be discharged or moved without telling the assistance company.

The short version

Buy it when you book. Declare every medical condition. Read the exclusions against what you actually plan to do - especially scooters and altitude. Make sure repatriation is covered without a small sub-limit. Save the emergency number offline. Then forget about it, which is what you are paying for.