Many international exchange program providers offer travel insurance coverage for emergencies such as lost luggage, evacuation and repatriation, as well as health insurance for medical treatment in the event of an accident or illness as part of the program fee paid by participants.

Professional organizations recommend that such insurance coverage be provided or required by their members as part of any international exchange program. Travel and health insurance are generally bundled together for complete coverage while traveling outside the United States.

This tipsheet is an excerpt from Building Bridges: A Manual on Including People with Disabilities in International Exchange Programs and focuses on travel health insurance as it relates to participants with disabilities on international exchange programs. It is important to separate disability from health. Most people with disabilities are not unhealthy or sick. By law, exchange program participants with disabilities are eligible for coverage under traditional group insurance policies.

Though traditional coverage will be sufficient for many participants with disabilities, some may request or need supplementary coverage due to limitations on coverage including treatment of pre-existing conditions or prescription medications.

If an institution or agency offers health insurance coverage for participants, there are a number of items to consider regarding coverage for people with disabilities.

• Pre-existing condition exclusions are an important consideration in insurance coverage for people with and without disabilities. It is important that travel health insurance covers treatment for unforeseen changes in a condition.
• Access to an individual’s medical records and personal physician in an emergency may be important for participants with health-related concerns, such as epilepsy, diabetes and others.
• Medicare and Medicaid coverage do not remain in effect while traveling overseas and certain services, such as personal attendant care, are unlikely to be covered under a travel insurance plan.

Frequently Asked Questions

How can an organization budget for the costs of comprehensive insurance coverage for all exchange participants and/or supplementary coverage for participants with disabilities?

Organizations may find it advantageous to join with an affiliated institution or similar organizations to purchase insurance coverage together in order to spread the costs of comprehensive coverage over a greater number of participants. However, an affiliation may not be created for the sole purpose of purchasing insurance together. If an association or consortium exists for other purposes, such as a coalition of community colleges, that organization may be able to purchase insurance at group rates.

Some exchange organizations have worked with their insurance companies to offer comprehensive travel/health insurance, including coverage for psychiatric care, chiropractic and dental care.

Add a line item for “reasonable accommodations” to program budgets in order to cover the cost of supplementary coverage for participants with disabilities who require broader coverage than that included in a typical group policy. See the Budgeting for Inclusion tipsheet for more information.

What if an organization opts to allow or require participants to purchase their own travel/health insurance?

It is important to verify that all participants have adequate insurance coverage while abroad. Some people with disabilities in the United States have medical coverage through Medicare or Medicaid. Neither of these will cover participants while they are outside the United States.

Participants providing their own travel health insurance should thoroughly discuss the requirements with their agent to be sure the policy will cover them outside the United States. If insurance is available through the program or organization, participants electing to purchase their own insurance will be required to provide evidence of a “mandatory plan with hard waiver,” meaning that the personal insurance coverage must be equal to or greater than that provided by the organization.

Does the insurance policy the organization offers cover pre-existing conditions?

A pre-existing condition is any medical condition, injury or illness that manifested itself, for which a licensed physician was consulted or for which treatment of medication was prescribed prior to the effective date of the insurance policy. Insurance company policies on pre-existing condition exclusions vary depending on the state in which the insurance company is licensed, so be sure to clarify this point in writing with your agent. Most insurance plans specify a period of time before the effective date of the policy as the exclusion cut-off. For example, if a policy contains a 30-day pre-existing exclusion policy, any medical condition, injury or illness that manifested, was treated or for which a new prescription was issued within that 30-day period would not be covered under the policy and any expenses incurred for that condition would not be reimbursed. A condition that had been present prior to the 30-day cutoff would be covered and expenses would be reimbursed. Additonally, some plans will include pre-existing conditions coverage after someone is on the plan for more than three or six months.

Group travel insurance plans sold in the United States generally have no pre-existing exclusion period. Because of this, participants with disabilities are automatically covered under those policies when they participate in a covered program. However, ongoing treatment or purchase of prescription drugs for a condition that existed prior to the effective date of the policy may not be covered.

Does the insurance policy offered by the organization cover expenses related to “treatment for unforeseen change in a condition”?

Unforeseen changes in a condition are covered by any policy that does not exclude pre-existing conditions or explicitly exclude the condition for which treatment is sought (some policies may exclude mental health treatment, for example). Examples of unforeseen changes that are disability-related might include a need for counseling, or treatment of a bladder infection, pressure sore or adverse reaction to a medication.

Does the insurance company offer an assistance service with a 24-hour, worldwide toll free telephone number for emergencies? Is it accessible to participants who use a TTY machine?

Most insurance companies that offer international travel insurance provide round-the-clock access through a travel assistance company. Services such as emergency hospitalization often must be arranged by the assistance company in order to be paid or reimbursed. Confirm with your agent that students needing emergency assistance will be able to get it, and that services including TTY or text messaging are available at all hours.

Can a medical office in the host country access an individual’s medical information and communicate with his/her physician if needed?

For participants with health-related concerns (such as epilepsy, lupus, diabetes, allergies and others) some Internet services offer the option to input and store personal medical information. That information can then be accessed from around the world in case of an emergency. It may also be possible to upload participant files, including health information (with appropriate permission and security assurances) to the organization’s intranet for access. See the Resources listed below for more information.

What health insurance options are available for students enrolling directly into a host university?

Students who consider applying directly to a university in another country should ask about health care coverage options. Students who directly enroll or are integrated into a host university may be eligible for the health services that students in that country receive. Students with disabilities should investigate whether they will need additional coverage, such as pre-existing coverage, because requirements may vary from country to country and institution to institution.

What are some ways to assist a participant with a disability who uses a personal assistant to think creatively about arranging for needs while overseas?

Participants who receive funding for a personal assistant through Medicare and Medicaid are not able to use that funding once outside the United States. Furthermore, there are currently no known independent insurance companies that will pay for personal assistants for daily care overseas. See the tipsheet for creative ideas on ways to fund personal assistants on exchange programs.

Resources

^{Note: Mention of an organization, company, service or resource should not be construed as an endorsement by Mobility International USA/ National Clearinghouse on Disability and Exchange. Although efforts have been made to assure accuracy, MIUSA and NCDE do not guarantee the accuracy of these listings. MIUSA/NCDE cannot be held liable for misinterpretation or complaints arising from these listings.}

CareMed USA

River Plaza, 9 West Broad St.

Stamford, CT 06902-3788

Tel: (203) 399-5155

Fax: (203) 399-5596

E-mail: kphillips@caremed-travel.com

HTH Worldwide

100 Matson Ford Road

Radnor, PA 19087

Tel: (888) 243-2358

Fax: (610) 254-8797

Email: fgillingham@hthstudents.com

International Student Insurance (ISI)

67 Coddington Street, Suite 201

Quincy, MA 02169

Tel: (877) 328-1565 or (617) 328-1565

Fax: (617) 328-0615

Email: webmaster@internationalstudentinsurance.com

Ingle International Travel Insurance

Imagine Financial Ltd.

460 Richmond Street West, Suite 701

Toronto, ON, Canada M5V 1Y1

Tel: (416) 730-8488

Fax: (416) 730-1878

E-mail: helpline@inglememberbenefits.com  

Travel Insurance Services

2950 Camino Diablo, Suite 300

Walnut Creek, CA 94597-0299

Tel: (925) 932-1387 or (800) 937-1387

Fax: (925) 932-0442

Email: info@travelinsure.com

Websites

The United States Department of State Travel Medical Information site provides travel and health information.

Medical Information for Americans Traveling Abroad provides lists of ambulance and medical services.

International Association for Medical Assistance to Travelers provides a directory of English-speaking doctors in 125 countries who provide medical assistance to travelers.

417 Center Street

Lewiston, NY 14092

Tel: (716) 754-4883

Email: iamat@sentex.net

Shoreland’s Travel Health Online Travelers health information; provides planning guide, country information, medical provider contacts.

Shoreland, Inc.

PO Box 13795

Milwaukee, WI 53213-0795

Tel: (800) 433-5256 or (414) 290-1900

Fax: (414) 290-1907

PersonalMD is a consumer health website that provides information on a wide variety of topics pertaining to health. One feature is the PersonalMD Emergency Card, which allows users to enter their medical information into a secure database that can be accessed anywhere in the world via the World Wide Web if there is an emergency.

4725 First Street, Suite 275

Pleasanton, CA 94566

Tel: (925) 417-6840

Fax: (925) 600-7568