Health problems sometimes affect visitors abroad. Information on health precautions can be obtained from local health departments or private doctors. General guidance can also be found in the Centers for Disease Control and Prevention's (CDC) book, Health Information for International Travel, available for $14.00 from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, or the CDC's international travelers hotline at (404) 332-4559.

Health Insurance. It is wise to review your health insurance policy before you travel. In some places, particularly at resorts, medical costs can be as high or higher than in the United States. If your insurance policy does not cover you abroad, it is strongly recommended that you purchase a policy that does. There are short-term health insurance policies designed specifically to cover travel. If your travel agent cannot direct you to a medical assistance company, look for information in travel magazines. The U.S. government cannot pay to have you medically evacuated to the United States.

The Social Security Medicare program does not provide for payment of hospital or medical services obtained outside the United States. However, some Medicare supplement plans offer foreign medical care coverage at no extra cost for treatments considered eligible under Medicare. These are reimbursement plans. You must pay the bills first and obtain receipts for submission them later for compensation. Many of these plans have a dollar ceiling per trip.

Review your health insurance policy. Obtaining medical treatment and hospital care abroad can be expensive. If your Medicare supplement or other medical insurance does not provide protection while traveling outside the United States, we strongly urge you to buy coverage that does. The names of some of the companies offering short-term health and emergency assistance policies are listed in the Bureau of Consular Affairs flyer, Medical Information for Americans Traveling Abroad. The flyer is available by sending a stamped, self-addressed envelope to Bureau of Consular Affairs, Room 6831, U.S. Department of State, Washington, D.C. 20520-4818 (or via the automated systems mentioned under How to Access Consular Information Sheets).

Trip Insurance. One sure way to ruin a vacation is to lose money because an emergency forces you to postpone or cancel your trip. Except for tickets on regularly scheduled airlines, almost any travel package you purchase will have a penalty for cancellation and some companies will give no refund at all. Regularly scheduled airlines usually give a refund if an illness or death in the family forces you to cancel. Airlines require a note from the doctor or a death certificate. Take careful note of the cancellation penalty for any other large travel purchase you make, such as a tour package, charter flight, or cruise. Unless you can afford to lose the purchase amount, protect yourself by buying trip insurance. If you invest in trip insurance, make sure your policy covers all reasonable possibilities for having to cancel. For instance, if an emergency with a family member would force you to cancel, insure against that as well.

Some trip insurance policies will give a refund if the company goes out of business or otherwise does not make good on its offering. The best insurance against company default is to choose a reputable company that guarantees a refund if they do not provide the services procured. If, however, you are tempted to purchase a tour at a great bargain price and you can't find a guarantee of delivery in the fine print, protect yourself by purchasing trip insurance that covers company default.

Shop around for the trip insurance policy that offers the most benefits. Some credit card and traveler's check companies offer travel protection packages for an additional fee. Benefits may even include accident and illness coverage while traveling.

Immunizations. Information on immunizations and health precautions for travelers can be obtained from local health departments, the Centers for Disease Control and Prevention's international travelers hotline at (404) 332-4559, private doctors, or travel clinics. General guidance can also be found in the U.S. Public Health Service book, Health Information for International Travel. Immunizations are normally recommended against diptheria, tetanus, polio, typhoid, and hepatitis A for travelers. Generally, these immunizations are administered during childhood.

Medical Assistance Programs. One strong advantage of medical assistance programs is that they also cover the exorbitant cost of medical evacuation in the event of an accident or serious illness. As part of the coverage, these companies usually offer emergency consultation by telephone. They may refer you to the nearest hospital or call directly for help for you. If you need an interpreter, they may translate your instructions to a health care worker on the scene. Another benefit that is normally part of such coverage is payment for the return of remains to the United States in case of death.

If your regular health insurance already covers you for medical expenses abroad, you can buy a medical assistance program that offers all the consultative and evacuation services listed above except for the health insurance itself. Cost of medical assistance coverage is usually inexpensive without health insurance coverage or a little more for the complete medical assistance program including health insurance. On the other hand, escorted medical evacuation can cost thousands of dollars.

If your travel agent cannot direct you to a medical assistance company, look for information on such services in travel magazines. Once you have adequate coverage, carry your insurance policy identity cards and claim forms with you when you travel.

Medication. If you require medication, bring an ample supply in its original containers. Do not use pill cases. Because of strict laws concerning narcotics throughout the world, bring along copies of your prescriptions and, if possible, carry a letter from your physician explaining your need for the drug. As an extra precaution, carry the generic names of your medications with you because pharmaceutical companies overseas may use different names from those used in the United States.

If you wear eyeglasses, take an extra pair with you. Pack medicines and extra eyeglasses in your hand luggage so they will be available in case your checked luggage is lost. To be extra secure, pack a backup supply of medicines and an additional pair of eyeglasses in your checked luggage. If you have allergies, reactions to certain medications, foods, or insect bites, or other unique medical problems, consider wearing a "medical alert" bracelet. You may also wish to carry a letter from your physician explaining desired treatment should you become ill.

Medical Assistance Abroad. If you get sick, you can contact a consular officer at the nearest U.S. embassy or consulate for a list of local doctors, dentists, and medical specialists, along with other medical information. If you are injured or become seriously ill, a consul will help you find medical assistance and, at your request, inform your family or friends. The list of English speaking doctors is also available before you travel by writing to the Office of Overseas Citizens Services, Room 4811, 2201 C Street, N.W., Washington, D.C. 20520. Please specify to which country you will be traveling.

Health Precautions. Air pollution abroad may sometimes be severe. Air pollution and high altitudes are a particular health risk for the elderly and persons with high blood pressure, anemia, or respiratory or cardiac problems. If this applies to you, consult your doctor before traveling.

In high altitude areas most people need a short adjustment period. If traveling to such an area, spend the first few days in a leisurely manner with a light diet and reduced intake of alcohol. Avoid strenuous activity, this includes everything from sports to rushing up the stairs. Reaction signs to high altitude are lack of energy, a tendency to tire easily, shortness of breath, occasional dizziness, and insomnia.

If possible, drink only bottled water or water that has been boiled for 20 minutes. Be aware of ice cubes that may not have been made with purified water. Vegetables and fruits should be peeled or washed in a purifying solution. A good rule to follow is if you can't peel it or cook it, do not eat it. Diarrhea may be treated with antimicrobial treatment which may be prescribed or purchased over the counter. Travelers should consult a physician, rather than attempt self-medication, if the diarrhea is severe or persists several days.

Charter Flights. Before you pay for a charter flight or travel package, read your contract carefully and see what guarantee it gives that the company will deliver the services that it is trying to sell you. Tour operators sometimes go out of business in the middle of a season, leaving passengers stranded, holding unusable return tickets and unable to obtain a refund for the unused portion of their trip. Unless you are certain a company is reputable, check its credentials with your local Better Business Bureau (BBB). The BBB maintains complaint files for a year. You can also check with the consumer affairs office of the American Society of Travel Agents, 1101 King Street, Alexandria, VA 22314, tel. (703) 739-2782 to learn if a travel company has a complaint record.

DEPARTMENT OF STATE PUBLICATION 10337
Bureau of Consular Affairs
Revised August 1996