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Travel insurance

Travel insurance is short-term insurance available specifically against travel-related emergencies and expenses. International travelers will almost always want to obtain travel insurance to cover possible medical expenses, but even other travelers may find it useful depending on their plans. As coping with an emergency during a trip abroad can work out to be very expensive, in general, if you cannot afford travel insurance, you cannot afford to travel.

This article describes common items covered by travel insurance policies and what to check for on your policy. With any policy, it is important that you read the terms and conditions carefully and that you especially review the exclusions (things that the policy definitely does not cover).

Understand

Travelers sometimes feel they can skip being insured if they're not carrying valuables, have changeable or refundable tickets, and can afford to be stranded at their destination for a while. Here are just four reasons that may not be the case:
 * Sickness or injury. Even though your health insurance costs may be covered at home by a government scheme or private insurance, it probably won't be valid outside your home country. Except for the occasional reciprocal agreement (such as in the EU), and the somewhat rare private worldwide policy, you won't have any health insurance abroad. A small number of countries extend free or mostly free public health care to tourists, but it may not be up to your standards. In addition, an accident or injury that wasn't your fault may offer little to no compensation in developing countries.
 * Medical evacuation back home or to the nearest suitable hospital can cost well over US$250,000 per evacuation. Even if you're covered abroad (per above), it's very unlikely to get you back home if you are seriously ill or injured beyond what can be handled locally or requires a lengthy recovery. This also includes children, infants, and pregnant mothers who should NEVER rely on their everyday health insurance for medical evacuation.
 * Stranded in a connection city. Not all delays and problems occur at your destination. International airline hubs tend to be located in major cities such as New York, London, Paris, Tokyo, etc. The cost for accommodation and necessities in such places is quite high.
 * Return travel at short notice can be expensive. Suppose you got an extremely good deal on an airline fare. Unfortunately, in the middle of your vacation, a non-traveling close family member passes away. It may well cost many times what you originally paid for the airfare to get back home, in addition to forfeiting the remainder of your stay.

These situations, plus many others, are explained in greater depth below.

Things that can be covered
There are two major classes of travel insurance:
 * International travel insurance, covering travel outside your country of residence. This is an essential part of international trips because many healthcare arrangements won't apply in other countries and you either need insurance or to be able to pay all medical bills out of pocket.
 * Domestic travel insurance, covering travel inside your country of residence. These policies are generally cheaper than international policies because they usually don't include medical coverage – you presumably have other arrangements in your own country. They focus on compensating you for purely travel-related problems like cancellations and closures. They are also much less essential and you can consider their worth on a trip-by-trip basis.

When buying travel insurance, you should review the dates of coverage (include the day you leave and the day you arrive home; unavoidable delays are often automatically covered), whether it protects you enough financially, and the exclusions.

As you digest the kinds of coverage discussed below, you may discover that you only need one or a few types, e.g., medevac (medical evacuation) from a trip location very far from home. With some research, you may be able to find separate coverage for each need. But if you need many types of coverage, you'll likely want an integrated policy that offers "broad spectrum protection", some of which you may not need. This, because the marginal cost of complete coverage is usually very small...likely to be far less than separately covering each of many risks. The "Example tables of coverage" below introduce you to the many kinds of risks that can be covered.

Medical expenses
Usually, whatever standard health insurance you have will pay only claims for medical care in your country of residence. Therefore, medical costs incurred abroad in many cases won't be covered. Some countries with universal healthcare (such as the UK and Australia) might have reciprocal agreements with other countries with similar healthcare systems. Some countries like New Zealand cover medical expenses of tourists arising for injuries and accident (e.g. car crashes) but not for illness or medical events (e.g. heart attacks). However, even if a country extends its subsidized medical care to tourists, what's provided may not be up to your standards or needs.

Unless you are covered by a reciprocal arrangement or your regular health insurance has international coverage, you may have to pay all medical expenses incurred while traveling out of pocket. Quality medical care can be extremely expensive. For example, a simple broken arm in the United States can easily cost $2,500 or more. Therefore, all international travelers should be certain that they have medical coverage, usually via a travel insurance policy that covers unexpected medical expenses incurred during their trip. Unless you won't be far from home, you should also opt for medical evacuation coverage discussed below.

Some hospitals may only admit you if you have evidence of a travel insurance policy or proof that you can pay.

When considering a travel insurance policy's medical coverage:
 * Check the precise details of medical care that you will be able to claim. If your destination has a tiered health system with, for example, public and private hospitals, are you able to use a private hospital?
 * Does your insurer offer 24-hour contact with emergency advice? These hotlines allow an insurer to assess a situation and give some advice about medical care as quickly as possible. Your insurer may have local knowledge that you do not have.
 * If you take part in any adventure sports or activities like alpine skiing or scuba diving, check your policy for medical coverage related to accidents that happen while you're doing that activity and whether or not you need any formal training to be insured. If you can't find a general travel insurance policy to cover your activity of choice, you may be able to take out a separate policy from an insurer specializing in that activity.
 * Is there coverage for illnesses that become apparent after your return? International travel insurance policies usually exclude medical costs incurred in your country of residence even if the costs stem from an injury or illness that happened while you were travelling. Medical costs in your home country are assumed to be covered by your normal healthcare arrangements. Some policies may cover tropical diseases such as malaria for up to a year. In rare cases, these can have long periods between exposure and illness.
 * Does the policy have adequate coverage for dental expenses? There could be substantial amounts available for general medical expenses, but only a very small sum, (for example, only $500) for dental expenses. In many instances, dental expenses are not covered at all unless you specifically purchase a dental add-on.

Caution: coverage for medical care does NOT automatically include medical evacuation.

Pre-existing medical conditions
If you have, or have ever sought treatment for, a medical condition, you should read the policy procedures on pre-existing medical conditions carefully. The insurer may
 * Refuse to insure you
 * Require you to undergo a medical examination
 * Charge you an extra premium
 * Increase your excess/deducible, or cap the amount they will pay
 * Exclude health care related to your pre-existing condition
 * Exclude all health care costs

You may have difficulty obtaining travel insurance if you have a high-risk, pre-existing condition such as heart disease, or have been diagnosed with contributing factors towards disease, e.g., clotting problems or extreme blood pressure. If asked, you may be required to disclose information about major, existing conditions in your medical history to your insurer, even if you are not seeking coverage for pre-existing conditions; your policy may be completely invalidated if you fail to disclose something pertinent.

Some policies may cover you generally, but with some or all pre-existing conditions excluded. This is obviously undesirable if you have an existing condition that causes you significant problems or leaves you at risk. However, some policies will cover medical and other pre-existing conditions, but only if you buy coverage within a short time after booking your travel, perhaps just 24–48 hours; some other insurers may allow up to two weeks. This is after booking, not after final payment for any major component of the trip. For policies that offer to cover serious conditions, any medical assessment (as above) may well render last-minute policy purchase impossible.

You'll find that it's worth considerable effort to first find quality coverage. Once you find such an insurer, you can then easily return to it to obtain similar coverage for later travel.

Pregnancy
If you are pregnant or are undergoing fertility treatment, you should read the policy information regarding pregnancy. Most policies consider pregnancy a pre-existing condition, even though they may cover with no additional information or cost required subject to certain criteria. The requirements vary substantially. Sometimes additional premium is required. Sometimes a letter is required from your obstetrician. Medical coverage may not be permitted beyond a certain stage of pregnancy. Different rules apply to multiple births, or IVF births. If you have ever been hospitalized due to the pregnancy, coverage may be denied altogether. Continued care of the infant might not be covered by your policy. Always have Medevac insurance in case of premature birth, or you will be stranded!

Refusal of medical coverage
Some pre-existing conditions will cause insurers to completely refuse all medical coverage, even for seemingly unrelated events. This will vary by insurer, but includes conditions like terminal illness, being an organ donation recipient, having AIDS, and similar systemic risky conditions. Such people may not be able to travel secure of receiving affordable medical treatment for any condition at all.

When medical coverage is refused, typically the other provisions of the policy still apply (e.g., claiming the replacement cost of stolen items).

Medical evacuation coverage

Some travelers have international medical coverage as part of their everyday health insurance, though it is rarely included in government-provided health care (except for reciprocal agreements among nations). However, health insurance virtually never includes medical evacuation. Even if you are willing to forgo all other types of travel insurance, you should never ignore medical evacuation coverage. As a rule of thumb, medical evacuation flights cost 200 times the equivalent one-way economy airfare (for example, a $750 airfare would correspond to a medical evacuation cost of $150,000). Unless you're a member of the billionaire club, you definitely need this coverage for long-distance travel (i.e. wherever traveling by surface while sick or injured would be impractical).

A medical evacuation is often a chartered trip (usually a flight) for a patient who is not well enough for other transport to better facilities or to their home country. It typically involves traveling with medical personnel looking after you throughout the return home, along with any needed equipment, medications, etc. Though the need is rare, its costs can be devastating to most peoples' savings, even lead families to bankruptcy. On-balance, the cost of coverage is not terribly high. In most cases, you should consider geography, rather than national borders, in whether or not you need this coverage. For example, someone living in Buffalo, New York who wants to visit the Canadian side of Niagara Falls would probably not opt to buy it. On the other hand, for someone living in San Francisco flying to Hawaii, it could mean the difference between returning to the SF Bay area promptly (albeit still hospitalized), and remaining stranded in Hawaii for months.

There are many reasons a traveler would need medical evacuation. In simple cases, after local treatment, you may only require medical monitoring, possibly on a commercial flight in first or business class to provide for more room. In moderate cases, you may be just well enough to travel with medical assistance while lying down, but not well enough to use a commercial airliner – especially if you have or had a communicable disease. If jumbo jet travel is possible, five seats in a row may be removed to allow you to remain laying down during the flight. Either you or the insurance company pay for all five. Though much cheaper than exclusive medical evacuation, it's reported to be quite uncomfortable. Some medical evacuation may be complicated by your condition and may result in extra costs; for example, people with decompression sickness ("the bends") cannot be evacuated normally by air, since fluctuations in cabin pressure can worsen the decompression sickness.

Some less-developed countries or the hinterlands of most countries may have no capabilities to treat serious injuries or illnesses. You might need to be immediately evacuated to the nearest suitable hospital for treatment, only to later be evacuated to your home country. The total price for this type of "double evacuation" can be extremely high, especially if the first hospital is relatively distant, and you're still very far from home.

Supplemental insurance (such as AFLAC in the USA) may cover medical evacuation, but only for about US$3,000. This is woefully inadequate for international travel. Domestic medevac is only intended to partly cover airlift to the nearest hospital (such as a helicopter serving an auto accident outside a major city), rather than evacuation to your home country while abroad. Make sure your policy covers at least US$300,000 or equivalent, and seriously consider opting for US$1,000,000 coverage (usually at a modest added cost). Also, don't confuse travel assistance programs for actual medevac insurance coverage. They may be able to dispatch an air ambulance, but you still have to pay. Make certain you're covered for DOUBLE evacuation up to the policy limit. If the insurance will only pay for one medevac, you could be stranded at a foreign hospital.

If injured far from the beaten path (a fight with a drunken polar bear in Churchill, Manitoba perhaps?) the "nearest hospital" with anything beyond the most limited capability may be farther (and more expensive as an emergency evacuation) than one may expect; domestic travelers may find a provincial insurance scheme covers basic hospitalization for injuries in another province but not a costly Arctic helicopter ride.

Caretaker coverage
If you are incapacitated while traveling, some policies will pay for a relative or friend to travel to you and either stay with you or escort you home.

Lump sum payments
In addition to covering your medical expenses if you are ill or injured, some policies will pay a lump sum to you or your estate in the event of an accident or untoward event. For example, they may pay you a fraction of your salary for a certain time if you are injured while traveling and unable to work.

Death
An insurance policy may cover expenses incurred by your estate related to your own death while traveling, such as the cost of arranging a local funeral and burial or cremation, or the cost of transporting your remains home. Having medical expenses covered by insurance is also very valuable to your next of kin in the event of your death as otherwise that person may be liable and your children and dependents may have their inheritance greatly reduced or canceled.

There may additionally be a lump sum benefit to your next of kin, though seldom anything approximating the amount of money a life insurance policy might pay.

Cancellation and delays
Travel insurance will often cover expenses related to unexpected cancellations by your carrier or destination providers, e.g., costs associated with or induced by a canceled flight, including accommodations, meals and other incidentals. Cancellations due to emergencies are often also covered; some possible examples include the following:
 * Medical advice telling you that you cannot travel
 * A death or (sometimes) medical emergency in your family
 * A major disaster at home such as a house fire
 * Disasters or upheavals at your planned destination that occur after you booked your trip

Depending on what's happened, the insurer might pay re-booking fees, refund lost deposits, or pay for travel home. Travel insurance pays only for direct losses such as these. You won't get additional compensation for being disappointed due to your holiday being cancelled. Also, there is no compensation for planning, preparation, items purchased for your trip, etc. In extreme cases, if you would really be sacrificing a lot of money if the trip were cancelled – even if all travel-related deposits and non-refundable payments were reimbursed – you'll have to contact a specialty insurer such as Lloyd's of London. An example would be a performer who's rented an auditorium or theater with a hefty deposit, as no travel insurance would ever cover this. Contact the specialty insurer first, as they may offer the usual travel insurance at a discount in addition to whatever special needs you have, if you buy both.

High-quality policies may cover your own discretionary cancellations if there is an exceptional circumstance: for example, some travel insurance policies will pay you the cost of your ski lift tickets if a resort has shut due to lack of snow. Very good coverage (with payment for quality options) may include payment for a major portion of unavoidable costs even if you arbitrarily decide not to take the trip.

There are always a raft of conditions about cancellations based on your purchase of certain coverage options. Not all policies have these exemptions. Shop around and compare if you find unacceptable terms. Examples of troublesome situations include:

 * You can purchase insurance covering a trip home because of the death of a family member, but a trip home due to the death of a friend almost certainly won't be covered, and even a de facto or engaged partner's death might not be. Non-immediate family is rarely included either, such as aunts, uncles, and cousins.
 * Family medical emergencies other than a death often aren't covered; for example the insurance might not cover a trip home to be with a family member who has been hospitalized or diagnosed with cancer – even if it's your own child.
 * If the family member's emergency isn't in the same city as where you started your trip, you'll have to pay any increase in airfare. Upon reunion, your policy may no longer provide any coverage, and you're on your own.
 * Many policies cover cancellations or delays due to terrorist activities occurring within the past 7 to 30 days prior to your arrival date, but very few, if any, will cover these due to the mere threat of terrorist activity. For example, if an attack occurred on 1 June, a good policy would allow cancellation for anyone whose arrival date is within the month of June. A "cheap" policy would only cover the first week. Should a subsequent attack occur, the clock would be reset – even if you booked after the first attack (assuming the destination is still covered by the company). Mere threats without an actual attack are not usually covered.North Korea - Sunan Airport (5015231895).jpg
 * If your transportation carrier shuts down, you may not get paid unless they declare bankruptcy. (Although bankruptcy protection is very commonly found in travel insurance policies, it only covers those of travel providers – never your own personal or self-employed business bankruptcy.)
 * If you have booked on a cruise line, canceling due to an epidemic in one or more port stops won't be covered if you bought the insurance from them. Third-party insurance is usually better, as they would be responsible for delays if there is a quarantine, plus any medical care, if you do get sick. (i.e. You have a much better chance of getting a refund.)
 * Although cancellation due to your home being uninhabitable (fire, flood, etc.) is usually provided, there is no coverage provided for renters or those leasing their home if the landlord wants you to move out. Do not take an extended trip if it would prevent you from having enough time to find new housing and move your belongings. Before booking a trip, always check your housing contract to find out how much advance notice the landlord must provide (may be superseded by more recent law), and important dates such as the end of the lease term.
 * Likewise, if you are the landlord of a rental home, or own a second vacation home (but are traveling elsewhere) there is no cancellation coverage provided in case of severe damage or destruction.
 * Most policies will not cover a strike if you book travel after union members vote to approve a strike (which could be weeks or months ahead of the actual strike). Also, be aware of de facto strikes such as a "sickout" – usually by just one segment of the airline (such as pilots). A few policies may not cover this, or cover it only as a delay.
 * It's easy to find cancellation coverage for being unexpectedly unemployed after booking a trip, with a minimum amount of time on the job (usually 3 to 6 months), but travel insurance does not cover lost wages if you're delayed in returning home. Instead, look for policies that pay a certain amount for each day of delay, without having to document expenses. If you travel frequently, save whatever you collect on claims for outbound delays. This can help make up for lost wages if you're delayed on the return trip.
 * Some policies cover cancellations if a destination is or has recently become unsafe due to a state of war (or "undeclared" war), but not necessarily due to a "travel warning" by your government.
 * If an actual "declaration of war" is needed to file a claim, it's highly unlikely your situation will apply, as no country has officially declared war since the end of World War II in 1945. Most conflicts after 1945 have been with one (or both) sides as non-state actors.
 * Sometimes the United Nations uses a "police action," and countries admit they're in a "state of war," but these can fall short of the definition.
 * Fundamentally, you're covered by a commercial agreement. The definition of war, conflict or safety is often not found in policy details.  So coverage may fall to the decision of the insurer...reason to take care with where you travel.  If thoughtful consideration raises a question, you might ask your insurer about your plans before committing to them.

Take care with cancellation waivers offered by tour packagers or operators and travel packagers or consolidators who've arranged your travel. If you or they must cancel, such waivers typically cover only what you've paid them, and not induced costs or other related commitments you've made. Waivers also won't cover your costs if cancellation is due to bankruptcy of the packager or operator. Good insurance often does cover such risk.

Key caveat: For any cancellation, you have a duty to minimize all induced, avoidable costs/expenses.

Resuming your journey
If you have to cut your trip short for certain reasons (usually illness on your part or on the part of a relative) some policies will pay the cost of an additional return ticket so that you can resume your journey later. This may apply only before a certain time (they won't fly you back if you had only 48 hours left of the holiday anyway!).

Extending your trip
If there's any chance that your trip might extend beyond the period of your insurance, make sure that you know in advance how you can extend the policy and whether you can do this while traveling. It is generally much easier to extend a policy if you request the extension while you're still covered: obtaining a policy when you're traveling but aren't already insured is difficult. In addition, if you let your policy lapse you will obviously not be covered for anything, including medical expenses, while you arrange a new policy. Many policies require that you apply for an extension at least 7 days before your policy expires.

When planning a trip, pay for your policy to cover a few days after your intended return. In the event of last-minute delays or changes of plan which extend your trip, you then have a few days to sort out any extension of the policy you need. Some policies will automatically extend if the delay is part of a problem that you could claim for: for example, if you have insured against delays and the delay extends your travel past the end of your coverage, the policy is automatically extended. This will typically not apply to pre-existing conditions or to high risk travelers such as the elderly, even if you fully disclosed pre-existing conditions when applying for cover.

Extensions to your policy are never guaranteed to happen. They will always be at the discretion of the insurer and may be refused based on your previous claims and any other information that you disclose when applying for the extension (and you will usually be required to disclose anything you think might be relevant lest the policy be void). Some insurers treat all applications for an extension as an entirely new application and will re-evaluate your circumstances before insuring you. Medical problems that occur during your holiday may count as pre-existing conditions when applying for an extension and certainly will if applying for a second policy.

Loss, damage and theft
Some travel insurance policies cover the loss of or theft of your belongings while travelling. Those covering loss or theft of belongings are typically among the more expensive policies, often aimed at business travelers. If claiming for theft, you must file a police report about the theft and get documentation, no matter how unlikely it is that the police will take any action. The insurance company will not pay your claim without a police report. In the Third World, always seek local advice before dealing with the police, especially for a relatively minor loss.

You may need to provide a list of items over a certain value and pay an extra premium to insure them. In the cases of expensive and easily disposed of items like cameras and laptops, policies may cover only violent theft or forced entry, e.g., if you leave your belongings in a room and they are stolen, coverage may be invalid if there was no forced entry. When considering claiming for damage, check the terms carefully: many expensive and fragile items are only covered if damaged while being carried by you. It is very common to exclude any damage done to your belongings if they travel as checked luggage--you must keep them on your person to be covered. Theft from unattended vehicles will have limited coverage, as will theft of, and particularly simple loss of, cash, money orders, travelers checks, and credit cards. For the latter two, contact the company, as they will usually reimburse your loss. (See the Money article.)

Personal liability
Personal liability will cover the cost of any damages, compensation and legal expenses that you are legally liable for as a result of your negligence. For example, if you accidentally burn down your hotel room, the hotel or its insurer may seek damages to cover the cost of the repairs and for lost income.

Common exclusions
Some insurers refuse to pay medical or any other expenses associated with particular activities. Some of these can result in significant costs that are not covered at all by insurance. Read the insurance policy carefully, but you may want to specifically consider:

 * Pre-existing adverse events — If you buy travel insurance after an adverse event (e.g. hurricane, epidemic) has been declared, you will not be covered for that event.
 * Failure to obtain necessary visas, etc. — If you're denied entry to a country because you forgot to obtain the necessary visa or travel authorisation, your travel insurance won't cover you cancelling your trip.
 * Riding a motorbike or scooter — Although common in some south-east Asian and Caribbean countries will not be covered if you don't hold a motorcycle licence, and that licence is valid in the country where you are riding.
 * Adventure sports — Injuries during these often aren't covered. This can including flying when not on a scheduled commercial flight (such as general aviation), or even a diving accident at a swimming pool.
 * Third party theft — If you hire a bike, or a motorbike, don't necessarily expect it to be covered for theft – even though your rental car might be.
 * Theft from checked luggage, and from cars — Valuables left in cars unattended, and laptops, cameras and other valuables checked-in to the aircraft often aren't covered. If from checked luggage, you might be able to file a claim with the airline.
 * Sexually transmitted diseases, including HIV.
 * Illegal activities — Remember, this means whatever the foreign country you visit defines as illegal. Laws vary greatly abroad.
 * Medical tourism – If you are travelling for medical purposes, you won't be covered for any costs arising as a result of medical treatment.
 * Accidents while under the influence of drugs or alcohol
 * Nuclear, biological or chemical weapons — Although unexpected terrorist attacks are typically covered by travel insurance, many policies explicitly exclude coverage for incidents involving either of these – regardless whether committed by terrorists or other actors.

Other exclusions also include anything that happened to you as a result of an act of war, insurrection or rioting. Suicide or self-harm is nearly always excluded.

Some policies may exclude all coverage in certain countries or regions within countries. This is usually due to danger or serious health issues. Check the fine print of your policy, e.g., in one section of the policy it may explicitly list a country as eligible for coverage, and then in another section exclude coverage in any country listed on certain government websites, such as the World Health Organization or Britain's Foreign and Commonwealth Office. However, some insurance companies cater to this niche market.

Usually, as soon as your insurer repatriates you to your home country, their responsibility for your health care ends (though malaria might be covered for a year).

Older travelers

Travel insurance becomes increasingly difficult to get after age 65, with your age alone being considered something of a pre-existing condition. The precise cutoff for receiving insurance without an additional premium and/or medical examinations varies from 55 to over 70 for some insurers. As you age, you will face increasingly higher premiums and perhaps excess charges or deductibles on claims, and your existing medical conditions may be partly or totally excluded. This varies somewhat by insurance company and whichever country you reside in.

Excess/deductible
Some policies have an excess or deductible amount. This is the amount you have to pay out of pocket before your travel insurance starts paying out. In general, the lower the deductible, the higher the insurance premium. Travel insurance with a $5,000 deductible can be as little as $10/month: that means you will have to pay out of pocket for minor expenses or even a mid-level problem like a broken wrist, but it will be a financial lifesaver if you have a serious accident.

Cautions about coverage
As noted above, quality coverage can be crucial. The legal terms will be declared in the detailed contract. You should be offered a copy before you purchase the policy, and carry it (in some form) with you while traveling.

To judge one part of that quality, review carefully terms that could "excuse" the insurer from paying benefits, e.g., going to destinations declared especially dangerous by your government, medical or medical evacuation costs induced by a terrorist act, or whether you have the option to cancel or cut-short your trip due to what you may (rightly or wrongly) perceive as too much danger...even an unforeseen forecast of terrible weather. If in doubt, call and discuss details of your trip and coverage with an agent of the insurance company.

Example tables of coverage
In concert with the above discussions, these tables reflect coverages under three kinds of multi-coverage policies offered by one reputable insurer as of 2012. The first table reflects “top level” coverage items. You should see most/all such features (and perhaps others) immediately mentioned by a policy. You'll notice that the "Moderate Coverage" (Cvg) and "Deluxe Cvg" examples here are better oriented to international travel.

This next table reflects sometimes hidden details of coverage, in this case just for “Trip/flight cancellation or interruption". A good insurer will explain any qualified details/exceptions behind every major/top-level type of coverage offered.

Some coverages may be increased by paying additional premiums, e.g., for rental car liability. Others must be obtained through a separate policy, e.g., under "Injury" you may have no coverage if you voluntarily participate in risky or violent activities such sky-diving or rugby...unless you opt and pay for a special option (or rider), perhaps after describing the activity to the insurer. If they decline, you face getting a separate policy, perhaps from the same insurer...if you're so inclined. Having already bought a policy, some insurers may allow you to later increase coverage... except for pre-existing conditions unless you bought it before or promptly after your first cost commitment to your trip (see "When to buy" below).

As discussed above, look at the details thoroughly, especially if contemplating a trip to distant lands. Once you have done this once and were happy with the insurer, for subsequent travel you may only need to quickly consider their same policy and options before buying it.

Buy
You can obtain travel insurance direct online, through your travel agent, your normal insurers, or any one of a number of specialist travel insurers. Shop around. Because travel insurance policies are somewhat interchangeable, there are a number of websites where you can compare policy costs.

Like most insurance, the lowest tier has the highest cost per amount of coverage. This occurs because every claim—no matter how large or small—feeds from the lowest tier. In comparison, very few claims go into the highest tier. If you want $250,000 of Medavac insurance, you're going to pay for it. But if you want $1,000,000 coverage instead, the premium increase is very modest. Of course it's a waste of money to insure your belongings for more than they're worth, but catastrophic injury, illness or a major delay could happen to anyone.

You purchase travel insurance for international trips through an insurer in your country of residence, i.e., the country to which you'd want to be evacuated to or return to after a serious medical emergency, and/or the country you'd need to travel to in the event of the death of a non-traveling close family member. These are assumed to be the same country. However, if you have close family residing abroad, many insurers would accommodate travel to any part of the world, provided you'd pay by credit card any difference in air fare.

If you are a member of a travel association or large professional group, you may find that it offers or endorses an insurance provider that provides extra cover or better rates. Failing that, you may find cover through an on-line search. But take care that the company has a good reputation, e.g., from friends/family who have had to file claims, or local travel agents (mere on-line reviews/ratings may not be genuine). The discounts available here can be huge. A $20 membership of your local bridge club may save hundreds when you realise you can be covered under their annual travel insurance.

Very regular travelers taking three or more trips a year may find that "ongoing" or "periodic" travel insurance, typically purchased a year at a time, can be cheaper than insuring each trip individually. As long as your ongoing insurance is valid, you don't need to remember to buy insurance every time you go somewhere and you will probably save some time and hassle as well. Most major travel insurers offer such policies. Large businesses often purchase such insurance for their key or frequent travellers. Beware that even as the travel insurance is ongoing, there may be a limit on how many days at a time you may be traveling — usually not more than one or a few months. This is because travel insurance is for travel, not a cheap solution for expats going abroad for months or years. If you're going on a very long trip, check this, and contact your insurance company if needed. In the U.S., if you travel out of state, you are covered by your health insurance back home for urgent care and the emergency room. However, you may not schedule "maintenance" appointments, even if it's the same multi-state insurer, with some limited exceptions. Always check in advance, or you may have to pay the entire medical bill.

Some credit card companies insure trips purchased with certain types of credit cards they issue. Coverage will almost always be strictly limited to the costs of travel so purchased. Credit card insurance may be invalidated for travelers who paid travel deposits in cash rather than using the card. Many cruise and travel agencies offer travel policies for travel booked through them. Costs and quality of coverage can vary widely, so examine terms carefully. Business travelers or university students on exchange may be covered by a company-wide insurance policy, but if you intend to take any side trips or have a short vacation check the coverage. Usually, these must be of a fairly short length to be covered by such a policy. Be sure to check any "existing deal" carefully, and ideally get confirmation in writing.

Avoid:
 * Flight insurance, sold at some airports, is simply a very overpriced form of accidental death coverage policy valid only for the duration of your flight. Don't waste your money; even casino gambling and lotteries have much better odds than flight insurance. To put this in perspective, since 2009, only one claim could have been filed over the death of one person in the U.S. for flying on a domestic jetliner.
 * Cruise insurance (most cruises should be insured, but not with this type of coverage). Temptingly modest in cost, many such policies cover few risks at very basic levels (rarely medical care or evacuation), only during your cruise, and only for activities/tours sold by the ship. In reality, you'll likely have many risks before, during, and after your cruise that won't be covered, such as troubles before the trip starts and flying to/from embarkation/debarkation ports. In contrast, coverage from a major travel insurance provider (i.e. they insure not just cruises, but all major forms of travel) is usually much better.
 * Airline insurance  While far better than flight insurance (above), it is also very restricted. These policies are sold at the time of buying an airline ticket online. You will usually get better value with a more comprehensive policy. Exception: If you're flying one-way to stay somewhere for months or years, this type of coverage might be the best. Always check the details for valuables and exclusions. Also, be sure to have insurance as a local resident would when you arrive.

When to buy
You will get the best value and coverage from your policy if you purchase it as soon as your travel plans are final. Your travel insurance will only cover you from the day you purchase your policy, so if you are injured and unable to travel the day after you buy your ticket you won't be covered unless you have already purchased your insurance. Any medical conditions you have or may develop between booking your trip and buying your travel insurance will be considered "pre-existing". Any outbreak of violence, anywhere on your itinerary, that occurs before you purchase your policy probably won't be covered by a claim; if after purchase, and great danger (e.g., violence/combat) can be expected, many policies will not cover their consequences. Natural disaster coverage can vary widely among insurers. After examining coverage descriptions on their web site (if any), consult with an insurer's agent for advice about their various policies, variable coverages, and any locations on your itinerary that may have or create complications.

You can purchase travel insurance as late as your day of departure, although if you have pre-existing conditions (some that may need to be evaluated and accepted by the insurance company) you would usually be out of luck. Basically, good policies/coverage options can cover many or all pre-existing conditions (sometimes at modest costs for those options), but only if you buy coverage within a very short time after booking your travel ("booking", as distinct from when you pay for it); a few others may allow purchase of such coverage up to two weeks after booking. (See "Pre-existing conditions" below) If you book a trip long before it will begin, better insurers will let you buy an initial policy that covers your trip deposit, unavoidable risks, and pre-existing conditions. You can then later increase the policy's monetary coverage by paying an additional premium for increased risks or trip expenses, e.g., right after you've paid the rest of the trip cost.

Costs
There are a number of factors that generally influence the cost of a policy.

 * Committed cost of trip. This means those costs (to you) which will be forfeit/lost if any travel must be cancelled.  For road trips, they may only include deposits or full payments for lodging.  For flying trips, they at least include airfares purchased.  For cruises, they can include flight costs plus those for the cruise... first perhaps a cruise deposit, later the final payment.  You would be wise to include a reasonable-worst-case estimate for possible, incidental costs induced by trip cancellation.
 * Number of travelers. Some travel insurers will cover dependents and families at a reduced cost.
 * Age. Once you/members of your party reach 55 to 60 years of age, premiums can rise (though it's common to give discounts to much younger travelers). At older ages, some companies refuse insurance entirely, or add a significant surcharge.
 * Duration. Policies are generally sold for date ranges, e.g., the defined duration of a trip. If your trip is just one day over the limit, you may not be reimbursed.
 * Destination region. Exotic destinations may be cheaper than destinations like North America, where health costs are higher.  But distance from home is a more basic determiner of risk to the insurer (and so cost to you), e.g., for medical evacuation.
 * Pre-existing conditions. These are usually assessed by the insurance company once you make a claim.  Coverage for them can result in an additional premium, seldom policy refusal. (As above, they may be covered if you sign up soon after booking travel with a good insurer.)
 * Additional coverage. See the example coverage tables above.  Some coverages listed can be individually increased depending on the details and needs/risks of your particular trip.
 * Valuables. There is usually a limit to value for loss or theft in the base policy.

Do not fail to declare to the insurance company all relevant details as you buy coverage; otherwise, they may not honor your claim.

Claim
Read your insurance companies procedures if you incur any expense that may result in a claim. If in any doubt, contact the insurer. Some insurance companies may require you to contact them before incurring any form of medical expense—they may have specific doctors and hospitals they will make arrangements with. If you require emergency treatment or are taken to hospital, inform them as soon as possible. Keep the expenses you incur to a minimum, and keep documentation for reimbursement.

Most policies require a police report to be filed for any items lost or stolen, but can offer an alternative in some cases, which can be useful in countries where it costs money to file a police report. You may need some proof of ownership to present with your claim.

Do not arrange your own evacuation unless your life is in danger and you or your companions cannot talk to the insurer first. As explained above, your insurer may have fully-effective, alternate means to arrange what you need, and avoid one-time costs with Medavac companies they don't normally do business with. Your travel insurance won't pay (or pay fully) if evacuation is otherwise self-arranged. In case of unavoidable self-arranged evacuation, go no further than what's necessary to obtain proper care—not all the way home (in most cases).

All claims should be filed promptly. Most insurers have a limited period of time after a given event for which you can claim associated expenses—usually no more than a year.

Your trip insurance is secondary coverage for your trip. That means you have to make every effort to recover your costs from other parties before making a claim. Ask for refunds from providers for all or part of the costs of tours, lodging, etc., that you had to cancel. Afterwards, make insurance claims for the outstanding amounts.

You have a duty to avoid unnecessary costs as you arrange for the premature end of your trip, e.g., notify tour operators/hoteliers of your circumstances and cancel what you can to obtain all possible refunds, don't use (or make claims for) five-star hotels and first-class air for the rest of your group if that was not already part of your trip.

False and exaggerated claims can be prosecuted in your home country as "insurance fraud." Overall, this causes everyone's premium to rise for insuring their trip.

Practical matters
Purchase of travel insurance still means that most clinics and hospitals may require payment in advance, or sometimes by incremental payment as various services are rendered. This may require access to a quite significant amount of cash to keep things moving...or at least an accepted credit or debit card with significant resources behind it. You'll later make any claim with the insurance company upon your return home. This is almost always the case if the problem is one that can be dealt with on an outpatient basis. For in-patient care, you're best off if your insurance company has an agreement with the provider or immediately establishes one...if feasible. Otherwise, your out-of-pocket bill (for your credit/debit card) can become very substantial.

Major travel insurance companies may be slow to respond with appropriate assistance and equally slow to refer a claimant to a suitable medical service...especially in less-developed areas. Delays may be experienced if the insurer is slow or indecisive in authorizing treatment. Difficulties may arise from an insurer not authorizing a guarantee of payment to the local medical services provider. Delays in rendering appropriate treatment or being prevented from leaving until the account is settled up, are common outcomes. Try to gain a comprehensive understanding of the policy terms and limitations of your travel insurance cover well before departing your home country. And try to understand the limitations of coverage and treatment during a political or military crisis as well.

Some travel insurance companies and their emergency response centers may not live up to your own expectations of regional knowledge, appropriate case management and speedy response. Your best approach is always common-sense, some basic pre-departure research about your destination and the application of good situational awareness whilst traveling. Try to have your own plan in place to deal with any crisis you may encounter when traveling rather than relying solely upon a perhaps inadequately skilled or under-qualified person sitting in a distant call center who may have their role complicated by problems with language. That can compromise communication and access to the insurer's decision makers.

If staying a while in one location, you may wish to carry the names and contact numbers of one or two of the major local medical and evacuation providers so that you know how to quickly obtain medical assistance should an emergency arise. Always ensure that you contact your insurer as soon as possible should an emergency occur. Otherwise, you may find out later that they are unwilling to accept any liability for payment for what should be legitimate expenses.

Always keep a thorough record of all expenditures for any service likely covered by your insurance, as well as communications with your insurer. This includes full and detailed invoices and receipts for all services provided and any incidental costs. If you do not understand the detail of anything you've been billed for, ask for an explanation. If an explanation is not forthcoming or it looks excessive or unnecessary, withhold payment or authorization until you receive an acceptable explanation.

Stay safe
Many insurers specifically exclude travel to countries and areas known to be extremely dangerous. As a rough guide, if your country's government recommends against any travel to a particular country or area, you will find it difficult to get insurance coverage or benefit from what you already have. As above, always check the terms carefully, and if you are traveling to an unstable region, keep an eye on the travel warnings for any updates that might invalidate your insurance or "neutralize" its coverage while there.

If you have to travel to a war zone for work, your employer will usually arrange and bear the cost for special insurance with very high premiums. Check with your employer before you leave to be sure.

Connect
If you are incapacitated, your travel companions or contacts at home will need to deal with the insurer, so make sure they have contact details and are legally empowered to act in your interests, e.g., in the policy. Most insurers have a 24-hour hotline that you can call. Often, this service is an advice hotline and the insurer may transfer you to their professional staff or those in your area to advise you about medical facilities and services available. If you or a travel companion can first inquire locally about medical capabilities, that can also be useful.

Make and carry copies of your policy and your insurer's contact details with you. They need to show the insurer's e-mail address and international phone numbers for advice/authorizations and making claims. Have another copy in your luggage and online (e-mail to yourself with attachment, or stored in the "cloud"). If traveling with a laptop or tablet, store a copy in its memory or disc (accessible without the internet). Also give policy/contact copies to traveling companions and relatives or friends back home willing to help. They must know with whom, and how you are insured. If you are traveling to more remote areas (especially alone), give a copy (or at least basic information) to whichever local person is most responsible for hosting your visit, such as the resort manager or tour guide.

Always legally authorize medical care for your minor children and teens when you travel apart. In many countries, minors cannot consent to medical treatment, and doctors can only provide emergency care without consent. Grandparents and other close family are not automatically authorized to consent. This applies equally to minors staying at home without a custodial parent, and trips where minors and their parents will be in different locations at times during their travels. Avoid casually written permissions, and use a power of attorney legal document, where you choose another adult to make such medical decisions. This can be any competent adult, and doesn't have to be (and usually isn't) an attorney. Ready-made forms are available from libraries, bookstores, or online, and just fill in the blanks. Check if notarization is required, and where needed, have a certified translation in the legal language of the country where the minors are staying. (Inquire with the embassy or consulate in your area.)

Don't forget to leave the documents with whomever is caring for your children. Instruct them to bring the documents to the doctor's office or emergency room, but not give it to any ambulance or paramedic crew. This is considered "essential care" (no permission needed), and you run the risk of the documents getting lost. It can wait until your children's caretaker arrives at the hospital, as it will be some time before permissions will be needed. Storing them in a safe place in the caretaker's vehicle may ensure they are not forgotten.

title: Travel insurance


text:
Travellers' diarrhea

Diarrhea (or diarrhoea) is a common traveller's illness. To some extent, it's unavoidable: no matter how fanatical you are about food preparation, it's still liberally sprinkled with millions of airborne bacteria. At home, due to this constant exposure to the local germs, odds are very high that you're already immune to them. But in other parts of the world, where the bacteriological fauna are new to you, you're far more likely to run into problems. Also, in warmer climates bacteria both grow more quickly and survive longer outside the body. Thus the scourges of Delhi Belly, the Pharaoh's Curse, Montezuma's Revenge, and their many friends.

As with respiratory problems in colder climates, intestinal problems in hot climates are fairly common and in most cases are distinctly annoying but not really dangerous. Take it easy while feeling miserable for a few days, drink lots of fluids, and usually you will soon be well.

There are vaccines against many of these, including cholera, typhoid and rotavirus. Consult a doctor several weeks before your planned travel, giving time to have any vaccines you need.

Understand
Usually the traveller's affliction is gastroenteritis, an inflammation of the stomach tissue (gastritis) or the small bowel (enteritis) or both, which causes abdominal pain and frequent watery stools. There may also be vomiting and fever. The commonest cause is viruses, but bacteria or protozoa can cause nearly identical symptoms. These are transmitted via fecal-oral contamination – contaminated water, shellfish from such water, contaminated food, dirty toilets, etc. – and the main defense is good hygiene.

A typical intestinal infection is quite unlikely to kill, though a patient may feel like it is going to, or even wish it would. However, as for apparent colds that might turn out to be pneumonia, some more serious diseases have intestinal upsets as their first symptoms. It is very important to monitor the symptoms and see a doctor if the condition persists or if unusual symptoms appear. Things to watch for are:

 * the acute symptoms persist for more than two days, or
 * there is blood or pus in your feces, or
 * the feces are black, which is caused by blood, or
 * fever goes over, or
 * you are getting chills as well as fever, or
 * the pain evolves beyond a nauseous kind of sick, or
 * other weird symptoms show up, e.g. skin marks

If such symptoms appear, then you may have something worse and should see a doctor. Do not try to just fight it off. According to WHO, diseases involving diarrhea kill more than 1.5 million people a year, so if you have signs of more serious illness, take them seriously. Of course in many cases the doctor will tell you it is not in fact serious, but do check.

Prevent
There's an old adage for eating in the Third World:

 * Boil it, cook it, peel it, or forget it.

This seems simple, but in practice it's a tough road to follow, the problem being not so much the risk of accident as the risk of temptation. For example, the following items are highly likely to cause problems:
 * tap water
 * ice
 * milk
 * fresh fruits and vegetables, especially leafy vegetables
 * raw eggs (as in mayonnaise)
 * meat that is not well done
 * raw fish and seafood

Test: It's another sweltering hot day in Delhi and that curry you just ate is still scorching your throat, so how about a nice strawberry shake to cool you down? If you said "Sure!", you may just have passed an intestinal death sentence on yourself: that shake contains as many as four of these high-risk items. The ice that makes it cold has either been made from tap water or, worse yet, comes from the factory in huge blocks that are often literally dragged down the street. Milk spoils very quickly in the tropics. And those yummy leafy veggies and unpeeled fruits have been washed in that same parasite-laden tap water... if at all.

Having read this, your instinctive reaction will be to panic and to head for the nearest expensive, air-conditioned tourist restaurant. Bad move. They're still using the same ingredients, stored with the same levels of hygiene or lack thereof, but because it's a tourist restaurant their business model relies on catching a couple of tourists a day, instead of feeding a crowd of locals. This, in turn, means that those same ingredients have, more often than not, been sitting around a long time waiting for you.

What to do then? It's a numbers game, but here are a few guidelines to improve your odds of escaping unscathed:

 * Choose local food. That's what they know how to handle. Don't go to that fancy tourist restaurant to have that steak or Russian salad you can eat at home and which they have absolutely no idea how to handle properly.
 * Choose a popular restaurant. Many people (especially locals!) means that the food isn't left sitting around, and more likely than not, it also means the chow is good and the price is right.
 * Be careful with street stalls. Often they lack running water, hygiene may be poor and the food may be exposed to street dirt.
 * Choose cooked dishes that are made on demand. Things like fried rice and fried noodles are popular in the tropics for a reason. Buffet-style meals, on the other hand, may appear cheap but are very risky.
 * Dishes that are kept boiling hot – in practice this means hot drinks and soup – are also a pretty good option.
 * Spicy food such as fiery curries and the like is usually OK since they're cooked, and the capsaicin in it acts as a natural disinfectant. On the flip side, excessive spices alone may be enough to upset your stomach's balance, so it's best to avoid these at least for the first few days if you're not used to them. Some shady restaurants use excessive spice to mask expired meats, if this is the case there is a good chance dishes where spice is not normally used will be highly spiced. Of course some legitimate restaurants will add spice in unorthodox ways too.
 * Avoid meat, fish, and especially shellfish; meat is often purchased from unsanitary open-air markets, where the chances of it harboring germs or disease are dramatically increased. Eating ground meat (meatballs etc) or anything not well-done is especially risky, not only due to food poisoning but because of the risk of things like trichinosis. Additionally, things like barbecues and roast chicken have to be prepared in advance, and who knows how long they have been sitting there?
 * Drink only beverages from untampered bottles and cans, and check the seals first! Don't let waiters pour stuff in the kitchen. Reputable restaurants will open their drinks in front of you for this very reason.
 * Heat fresh milk thoroughly before drinking it, or use condensed or powdered milk instead. If you are mixing up powder (formulae milk) boil or sterilise the water used first. Milk should be slowly heated to 72 C and held there for at least 15 seconds; don't heat it too fast as it will cause the milk to curdle.

The good news is that in a couple of days you'll start to acclimatize to the local bacteria and your odds of getting sick will start to decrease. The bad news is that it only takes one fly in the wrong place at the wrong time to foil all your precautions, and that if you stick around for a while, a run-in with food poisoning is, alas, more or less inevitable.

Dukoral is an oral cholera vaccine that also gives some resistance to diarrhea caused by enterotoxigenic E. coli (ETEC). It is only partly effective, so still take all the other precautions as well. It is available over the counter in a few countries and states and by prescription in others.

Treat
So one day your luck runs out, and you find yourself feeling distinctly queasy. Runny bowels or simple diarrhea don't really qualify for food poisoning, but if you...

 * feel sick and dizzy
 * get a fever
 * start to feel like you need to throw up

...then, well, you're reading the right article. The first thing to do is to get the acute phase over with: head for the toilet, kneel in front of the bowl and let go. You won't start to feel better until you start throwing up, and you won't get this over with until your stomach is empty, so just do it. Do not attempt to eat anything, and do not drink anything other than water yet. When there's nothing left, wash your mouth, brush your teeth and go to bed. You'll feel more alive in the morning.

Drink
Any form of diarrhea can cause dehydration; see the linked article for more detail. You're losing fluids constantly from any number of orifices, and your symptoms will become worse if you start to dry out. Headache or dark-coloured urine are common signs of dehydration.

For mild cases of dehydration, plain water, oral rehydration mixture (available from pharmacies), weak tea (sweetened), flat soda, and some diluted fruit juices are all good (but avoid vitamin C). Drinking a glass or two an hour till everything stops running out the other end should stop you becoming too dehydrated. Aim for drinks at room temperature. Do not drink caffeinated drinks or alcohol. Carbonated drinks should be allowed to go flat before drinking.

If you are vomiting intermittently, you should drink in regular sips rather than one big glass or more of water. Start sipping about half an hour after each vomiting episode.

Eat
For the next few days, you will find that your appetite has all but disappeared. Don't force yourself to eat. If you feel like eating something, stick to bland, stomach-friendly foods like rice, porridge, crackers, and bread. But be aware that food for you is also food for any bug that has made you sick, so take it slowly and stop if things get worse. Eat to match your appetite: Don't chuck down large quantities of food to make up for the last few days, instead eat small portions spread out over the day.

Avoid oily foods and most dairy products. Yoghurt and similar products, however, are OK since the lactobacteria have broken down the hard-to-digest parts.

Some people find that — as a preventative or in treating mild cases — yoghurt, buttermilk and similar products help. They are bacterial cultures; the hope is that their benign bacteria will overwhelm the nasty ones (and replace some that you lost during the sickness). Choose a "natural" product: most flavoured yoghurt has been heated, killing the culture. This is a fairly well established idea in travellers' folklore but attempts to confirm it scientifically have not given clear results. Do not try this if you are acutely ill; you will just heave up the yoghurt and feel even worse.

Though much oily food can cause diarrhea, it actually might be best to eat from international food chains (McDonald's, etc). These restaurants tend to follow strict sanitary rules. However, if the restaurant looks questionable and unclean, don't eat there.

Medicate
Most experienced travellers in high-risk areas carry an antidiarrheal drug (often loperamide, sold as Imodium and other names) as a safety precaution. It can be quite difficult to get to a pharmacy if you are ill, so it is sensible to be prepared. These can provide considerable relief from the symptoms of an upset stomach, but they do nothing to cure the disease. It is usually wisest not to take an antidiarrheal just to get some relief. You are likely to recover more quickly if you just endure the discomfort, drink your fluids, and let your body get on with the business of expelling the nasty stuff.

Where these drugs become essential is when you have something to do that will mean you have no easy access to a toilet, e.g. your visa is expiring so you must go renew it or you have a flight booked. Even then, it is definitely not a good idea to use these drugs for more than a day or two at a time; with no output your innards can become severely clogged, which will be quite uncomfortable and may even be dangerous in extreme cases.

About the only other treatments you might try without medical advice are Bismuth subsalicylate (Pepto-Bismol) to soothe the stomach, and ginger which is a natural remedy against vomiting. Either may provide some relief without blocking anything up if diarrhea is not too serious. Don't take aspirin (acetylsalicylic acid) to calm things down — aspirin requires a healthy stomach.

Other drugs may also be used, but usually should not be without a doctor's advice:

On no account take antibiotics without consulting a doctor first! One problem is that antibiotics are completely useless against viral infections. Another is that they kill off microbes that are needed as part of the digestive process. Most important, overuse or improper use of antibiotics helps create resistant microbes.
 * An antiemetic reduces or eliminates vomiting.
 * An antispasmodic reduces painful spasms in the digestive tract.
 * Metoclopramide (MCP) or domperidone (both sold under various names) will stimulate bowel movements, reducing stomach pain and nausea while facilitating natural expulsion of the bad stuff. In most countries you will need a prescription for MCP, in some also for domperidone.
 * Antibiotics may be prescribed in severe cases. However, a common side effect of antibiotics is diarrhea – take only as prescribed by your doctor.

Treat others
If your travelling companions are down for the count, the best thing you can do for them is supply them with water and rehydration solution, and, alas, possibly clean up after them. Wash your hands with very warm water and soap after cleaning, touching the sufferer, handling their clothes or bedding, and of course before eating.

Some groups of people are very vulnerable to dehydration after developing diarrhea. In particular, because of their small bodies, toddlers and babies dehydrate extremely quickly; elderly people also dehydrate more quickly than young adults, and any illness is serious in someone immunocompromised (eg, by AIDS or chemotherapy). A baby with diarrhea should be taken to the doctor immediately if it is under 3 months old, and also if it is older and is either vomiting, has a fever or has stopped wetting its nappy regularly, as this means it is dehydrated.

Remember to bring sufficient baby wipes, much stronger than toilet paper.

Don't share
Once sick with vomiting and/or diarrhea do not, if at all possible, prepare or handle food that other people intend to eat as you may infect them with your illness. Continue not to handle others' food for at least 2 days after the symptoms are gone. Sufferers should be extra vigilant about washing their hands thoroughly with warm water and soap before meals and after using (or cleaning) the toilet to make sure the germs do not spread.

Avoid using the same toilet with an infected person if you can. Reserve and quarantine one toilet for the use of the infected person (it still has to be kept clean, though) and use another one for yourself (or make sure the others use it if you are the one who is sick). If this is not possible, you (or someone else) have to use the same toilet with someone sick, disinfecting the toilet with household bleach after each and any use (defecating, urinating, throwing up, you name what else) by the infected person is a wise precaution. Although not very environmentally friendly, household bleach is generally the cheapest and most common option available (it has different names in different countries (for example eau de Javel in French-speaking countries, after the name of the town which it was first produced), if you don’t know the local name, check the label, it will state that it contains “sodium hypochlorite” (substitute “natrium” for “sodium” in some of the Germanic-, and Slavic-speaking countries), sometimes with the percentage: up to 5%). Pour the bleach on every part of the toilet bowl that was possibly in contact with the bodily wastes after all the solid dirt is removed (solid material hinders disinfecting properties of bleach). Don’t flush bleach down immediately, let it sit for at least 5-10 minutes so it has enough time to kill the nasty bugs.

Some food-related illnesses can spread rapidly through groups of people particularly where the group is regularly gathering for meals. If you are travelling in a group of people (particularly in a closed environment like a cruise ship) or attending a conference or similar gathering it is good to inform the organisers or medical staff if any of your illness so that they are alert to a possible problem for everyone else.

Complications
Sometimes a bout of diarrhea is the first symptom of something worse. If you have reason to suspect any of these, see a doctor, as the following conditions require medical care.

Cholera
Cholera is an extreme form of diarrhea, identifiable by torrents of liquid stool with white flecks of mucus ("rice water stools"). The skin and lips may turn dark and the eyes may sink due to dehydration. The disease is caused by the Vibrio cholerae bacterium and is generally transmitted by unsafe drinking water or food. Historically, it was one of the major killers; some cholera epidemics wiped out hundreds of thousands.

What kills is dehydration; untreated cholera kills more than half of its victims, often within 24 hours. Re-hydration is the main treatment; that alone reduces the risk of death to under 5%. Often intravenous fluids are required as well as fluids by mouth, since a cholera patient can lose over a liter of fluid an hour via diarrhea and it is hard to drink enough to replace that, and to keep it down if you do. Antibiotics may also be used.

Today the disease is rare in most places, but still present in the Indian subcontinent, Southeast Asia and parts of Africa; it still affects 3–5 million people a year and kills tens of thousands. Almost anyone planning travel to areas with cholera risk should get a vaccination; consult a doctor for details. Vaccines have been available for some decades, nowadays oral as well as injected. None of them gives full protection or is effective for more than 2-3 years. Three oral vaccines – Dukoral, ShanChol, and Euvichol – have WHO approval, but in the US only Vaxchora is FDA-approved as of mid-2020. Dukoral also provides partial protection against some other stomach infections.

Dysentery
Dysentery is an inflammation of the intestines resulting in diarrhea with blood or pus in the feces, often accompanied by fever or painful stomach cramps. The most common visible sign of intestinal bleeding is that the feces are black. Dysentery occurs more commonly in the tropics and is closely linked to poor hygiene; it remains a devastating illness in much of the Third World, but can be easily treated with modern medicine. There are two major causes:
 * Bacillary dysentery (or shigellosis), caused by Shigella bacteria. Transmitted through fecal-oral contact, with time from exposure to symptoms being 12-50 hours.
 * Amoebic dysentery (or amoebiasis), caused by the Entamoeba histolytica amoeba. Transmitted through contaminated water, can remain dormant for a long time and only appears after a period of weeks or months.

Dysentery can be confirmed by a stool test, but differentiating the bacillary and amoebic types takes at least 48 hours, so medication for both is often started simultaneously. The condition can usually be cured with five days of treatment with antibiotics (for bacillary) or metronidazole (for amoebic), and hospitalization is usually only necessary if fluid loss is extreme. The stool in dysentery can be highly contagious, so frequent handwashing for caregivers is essential.

Typhoid fever
Characterized by slow buildup, up to a week, to high fever (40°C) with heavy sweating and, in later stages, delirium. Diarrhea is green and bloodless; however, some people have constipation instead. Caused by the Salmonella bacterium, identified by blood or stool test, and usually easily cured with antibiotics. Untreated cases have 10-30% fatality rates and even the survivors may be thoroughly miserable for up to a month.

Vaccination is recommended for travellers to certain countries, including most of the "Third World". Both an injected and an oral vaccine are available; neither gives 100% protection.

Giardiasis
Also known as beaver fever, this can be identified by explosive diarrhea, foul-smelling flatulence and vomiting, often starting 1-2 weeks after infection and recurring in cycles. The cause is the Giardia lamblia protozoan, which is transmitted by the fecal-oral route, and often strikes people consuming untreated water in the wilderness and also in countries with poor hygiene. It can also be acquired from the tap water systems of some places, like St. Petersburg in Russia. Two-thirds of the people affected are silent carriers, and the condition often resolves with time. However, once identified, giardiasis can be cured with a single dose of tinidazole. Metronidazole is a common alternative in poorer countries, and is often available from pharmacies.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Travellers' diarrhea


text:
Travelling alone

Whilst travelling with friends or organized groups is fairly common, by choice or by necessity many people travel alone. Travelling alone is a unique experience and can be a very rewarding way of traveling, despite a few drawbacks.

Business travellers might find themselves on a solo trip, as well as long-time travellers such as gap year travellers.

Understand
"One travels more usefully when alone, because he reflects more."

- Thomas Jefferson

Traveling alone is not uncommon and most solo travelers are able to meet other travelers at hostels, bars, organised tours or any place where travelers tend to hang out or congregate.

Advantages of traveling alone

 * Your time and budget are your own! It's all up to you how much time to spend someplace, what your daily modes of travel will be, etc. You need not take into account the preferences and demands of a traveling companion. You don't have to worry about boring a companion or vice versa. You also have more space to make your trip entirely your own. Solo travel can be a great opportunity for reflection and moving at an individual pace. (You are likely to bring whatever problems you have with you, but you may gain a different perspective on them, and if it's your first time travelling by yourself, you may have the privilege to discover just how resourceful you are.) Traveling by yourself, you only have to please yourself.

 * It's easier to make friends with the locals. Many great opportunities to interact with the locals on a personal level can be found and enjoyed without a friend or other companion.

 * You don't have any social obligations. You have space and time to be yourself, apart from your family and work roles.

 * You will be far more flexible than non-solo travelers, and may find it easier to cope with unexpected setbacks and complications. For instance, if a flight or hotel is overbooked, you can make alternate plans more easily. There's nobody to blame you for your own gaffes, after all!

 * You can more easily change plans, as you don't have to run your spontaneous ideas by all other members of your group. Do consider however, that most plane and train tickets have limited refundability and some hotel reservations are difficult to cancel (or keep all or part of your pre-paid money)

Disadvantages of traveling alone

 * Personal safety can be a concern as there's nobody to watch your back and no one to share the driving should you get tired. There's also no one to watch the luggage while you go buy train tickets. You will have to carry all your gear yourself, which can be both inconvenient and stressful.

 * Arrangements may be more expensive on a per-person basis, as there is no one with whom to share costs. Although transportation tickets are priced individually, hotel rooms are generally designed and priced for two people (with either a double bed or two single beds), and as such, charge the same price to a single traveler occupying the room. The same principle applies to renting a car if you so desire. You may therefore need to budget a little bit more than if you are traveling in a group. On the other hand, this disadvantage can be mitigated by limiting visits to restaurants, opting instead for less expensive alternatives.

 * Some activities, such as eating alone in restaurants, can make some people self-conscious.

 * You may experience moments of loneliness, as you have no-one to talk to. However, with nearly ubiquitous cell phone service in many populated areas, it is easier these days to stay in touch with people at home if you so choose and can bear the cost. It's also easy to keep in touch with friends back home using email. Finally, unless you are trekking through the Sahara by yourself, you are almost definitely going to be around other people. Try striking up a conversation with some of them!

Talk
If you are travelling by yourself in a region whose language you do not speak, it's particularly important for you to learn at least a survival level of the local language if you have no travel partner to converse with, strategise with, and potentially fall back on. It's really not so hard to learn basics of any language today. You can start with Wikivoyage's phrasebooks, but also make sure you hear some basic words and expressions pronounced and practice saying them before you go, if at all possible. Borrow some teach-yourself CDs at your local library and/or look for videos on websites. Common languages (that are more likely to be understood than English even in some places where they are not the native language) like Spanish (Instituto Cervantes), German (Goethe-Institut), Arabic, Russian, Mandarin Chinese (Confucius Institute) or (especially) French (Alliance Française) can be studied at universities or cultural representations of the country they originate in for quite affordable prices almost everywhere.

Look for organizations or venues which are visited by people of your own kind. As an example, Russians abroad usually go to chess clubs to find their countrymen. As stand-up comedy is traditionally an Anglophone art, many cities have comedy performances in English, with a crowd which can be presumed to speak English.

Get in
Some destinations lend themselves better to solo travel than others. You may find places where accommodations for a single traveller are less restrictive or expensive. There may also be places that cater to individual travellers.

Get around
If you can afford a taxi and speak the local language, the driver can be a good companion.

Pack as light as possible. When travelling with friends the burdens can be shared; one person can watch the gear while another waits in line for train tickets, buys drinks or goes to the toilet. By yourself, you'll probably have to bring your things everywhere you go and prepare for tasks on your own, and having a heavy set of gear may not work.

When you have a choice, consider taking intercity trains instead of buses, so you can move around freely and mingle with other passengers. On most long distance trains the locals bring along a picnic, so take some extra food to share with your new friends. Longer flights (about more than 5 hours) can also a be good opportunity to learn to know fellow travellers.

Try not to look at maps in busy streets of foreign cities (which will mark you as an easy target for pickpockets) - do the map reading in a café, and unwind for a while, the refreshment will help you get your bearings. In many cities using a mobile device will blend better than standing on a street corner with a map, but in some parts of the world it's a bad idea to flash a smartphone worth four months' local salary! An inconspicuous alternative is to print out a map, cut it in palm-sized pieces and staple together the parts you'll need for your trip.

Do
Guided tours, especially walking tours, can be a great way to meet other travelers. They are offered in English at many destinations, and a place to meet other English-speakers.

Photos
Lone travellers have a difficult time getting good photos of themselves; selfie mode on smartphones gives lower performance than regular mode, and selfie sticks might feel awkward. In certain places, lending your camera or phone to a stranger in the street is a risk factor.

Some smartphone cameras can also be triggered using smartwatch apps or hand gestures. Using a small tripod or leaning your smartphone against something can allow you to take photos of yourself when used in combination with these options.

Whenever you have some time with a trusted companion (or hospitality staff that is not too busy), ask them to take a photo of you. They can take it with their own equipment, and send it to you.

Eat
Try to find places with a casual atmosphere in European cities, such as cafeterias in department stores, a pub, or an outdoor patio during warmer weather. Other good places are fast food and takeaway restaurants, diner-style lunch counters, cafeterias, buffets, street food stands, pizzerias offering pizza by the slice or personal pizzas, eateries at hotels, grab-and-go food from convenience stores or supermarkets, and food delivery (directly from a restaurant or through an app). If your hotel offers it, room service is an option if you want some privacy, but it can be expensive. A cheaper option for in-room dining if your hotel room has a microwave oven is to buy frozen meals and reheat them in your room. A number of hotels have on-site convenience stores where you can purchase food, though it will probably be cheaper to buy food at a local grocery store if you wish to prepare your own meals. Plus, it's a great way to meet locals.

Also, if you wish not to stand out, you may prefer to pick establishments where you're not the only person eating alone. An expensive and exclusive place not located at an accommodation is the worst choice in this regard in some parts of the world. However, in American cities like New York, it's extremely common for people travelling alone to be able to sit at the bar of even the most highly praised high-end restaurants, and they are often able to order from the full menu there. In Japan, single individuals can reserve places at the counters of great sushi/sashimi restaurants and have omakase (the chef's choice) while interacting with the chef. At the low end, it is completely natural in Japan for single individuals to sit down at the counter of a ramen house and have a great inexpensive meal.

If you go to an empty bar or café, the staff is usually idle, and might be happy for a talk with a guest. For their own marketing, they prefer to have a place that is not completely empty. If you are lucky, they might even give you a special offer.

Sleep

 * In places where accommodation is expensive, you can try to team up with other single travelers to share a room and split costs. A good place to meet people for sharing is on the bus/train/plane in to a new place. Be cautious about who you trust, obviously, but it can be a great way to save money.

 * The more travel-friendly the accommodation, the easier it will be to make new friends. If you're feeling lonely, head to a hostel, not a five-star hotel. Hostels are normally filled with solo travellers, many of them looking to make a friend or two to enjoy a beer with.

 * Many hospitality exchange offers are one-person only. And in any case, they might allow more personal contact with the hosts, than you would get with hotel staff.

Cope

 * Travel forums can also be a good way to meet other travelers who are in the same destination as you.
 * Buy someone a beer! Start up a conversation! Even if you're not outgoing at home, now is the time to start. Ask someone that looks like they've been there a while about cool things to see. Politely offer help to someone just arriving, if you know the hotspots (but don't be overbearing) Better yet -- talk to the locals. In some countries, guesthouses are staffed by young people who like making new friends. Ask a local to teach you a few phrases in her language. Ask a local how to make a toast in the local language. Don't be afraid: at worst, you'll never see these people again, at best -- you'll make a new friend.
 * Ask people to take your picture or offer to take theirs. It is a great way to initiate a conversation.
 * Try something like couch surfing to see if you can find some local to host you. You can get a much richer cultural experience that way.
 * Appearance and courtesy matters. Because you meet a lot of people in a short amount of time when traveling, it helps to put "your best foot forward". Prefer clothing similar to local fashion.
 * Smoking may be out of fashion back at home, but in a lot of the world, offering up cigarettes is not a bad way to strike up a conversation.
 * If you are up for romance, consider online dating. Most online dating service allows you to change your stated location, so you can find a match well before arrival. However, be honest with your intentions, and make your plans clear with a presumptive partner, to avoid heartbreak. Use barrier contraception. Be aware that dating culture and gender roles differ a lot between countries, even between those that otherwise have much in common. There might also be prejudices against relationships between foreigners and locals. Also be cautious about dating scams.
 * In larger cities or in towns with a significant presence of a certain diaspora there are often supermarkets that cater to those communities and try to offer as best they can "food like back home". While they are often tiny and tucked away in otherwise residential neighborhoods they are usually advertised with the diaspora language and owned by a member of the minority in question. Besides being a good place to meet and talk to countrymen or locals who like your culture (or at least its food) they can also help you get the absolutely essential food item from back home when you feel homesick.

Stay safe
Life is for the living, so don't go crazy with worrying, but a few simple measures can make your solo trip a lot safer:

 * If at all possible, arrive at a new place in the daytime. This will give you time to scope out accommodations and get your bearings in the relative safety of daylight. Some places are fine in the day, but dangerous at night. Some places are dangerous in the day, but imagine how much worse they are at night!

 * Keep a spare stash of cash and other important things, in a different place than you normally keep your money, as you have no one to spot you if you lose your wallet or have your things stolen. See also pickpockets.

 * Pay attention to your instincts. If your gut tells you not to get into that cab, take another one. If you have a bad feeling about a neighborhood, a hotel, a person, stay away. Your intuition often picks up on tiny signs of danger before you consciously identify them.

 * Be careful about drugs and alcohol. You don't have anyone to watch your back/assist you, or drag you home if you get too drunk to walk. It's a lot harder to make good decisions about who to trust, where to go, what to do, if you don't have your wits about you.

 * Also be cautious about dating, or other sexual adventures. Carry condoms if there is any chance you will go to bed with anyone. See dating scams for some problems that often arise.
 * Single travellers, especially men, almost anywhere will likely be approached by prostitutes (quite possibly of both genders), some will no doubt look tempting, and in some countries they are remarkably cheap. However, prostitutes anywhere are a risk for sexually transmitted diseases, in many countries the trade is illegal and in some the penalties are extremely harsh.

 * If you're in a semi-dodgy place for more than a short time, try to develop relationships with locals you trust. If you find a good taxi driver (who isn't driving drunk), ask him if he's available to drive you on other days. If you find a good guesthouse/hotel where the staff seems reliable, stick with it. Find a favorite bar, make friends with the barman -- someone who will stick you in a cab when you're too drunk, and who won't set you up to be mugged in a back alley.

 * Outdoor life alone can pose a danger. Prefer group tours, or locations which are not totally deserted.

title: Travelling alone