Few vacationers expect to get sick or injured on their overseas trips. But those who do often find that making sure they are covered by health insurance while traveling can pay big dividends.

While most standard health policies cover travel within the United States, many private plans don't cover care abroad or limit the types of expenses they will pay. Even when private health insurance pays for medical treatment outside the United States, it doesn't usually provide assistance in finding doctors or hospitals abroad. And for elderly travelers, Medicare does not cover overseas expenses, although some Medigap policies will pay for international health care, according to the American Association of Retired Persons (AARP).

Such coverage comes at a cost, however. Travel health insurance can be purchased separately or bundled with broad trip cancellation policies that cover lost luggage and many other services. Individual travel health policies begin at about $100 per person. Broad trip cancellation policies that also cover health insurance and medical evacuation run between 3 to 14 percent of the total trip cost, a September 1998 survey by Consumer Reports found.

"You are paying a high markup for something that you may never need to use," said Laurie Berger, travel editor for Consumer Reports, which plans to publish a roundup of travel health insurance policies in its October travel newsletter. "However, if you are in a high-risk medical category, are older or sickly, it pays to buy it, especially if you are planning an expensive trip or going some place remote."

All travelers, regardless of their age or health status, should check on their insurance coverage before they leave home to make sure they understand what type of risk they would assume if they were to become sick, experts say. Tourists visiting countries where they don't speak the language, those going to countries with poor medical facilities and people who have chronic health problems are advised to be especially careful about getting insurance.

"You don't want to start dealing with a health emergency at 3 a.m. in an unfamiliar place where you don't know the language," said Bradley A. Connor, a spokesman for the International Society of Travel Medicine.

Travel health insurance not only pays for medical care abroad but also often provides telephone consultation with health professionals 24 hours a day as well as referrals to local clinics and hospitals that meet American standards of care.

"There are certain places that are not up to the standards that we enjoy in the United States and North America," Connor said. "Sometimes there are places where needles are not sterilized and blood is not screened."

For insured travelers who face emergencies, medical teams are also available to escort patients and a companion home by private air medical services. Ill or injured travelers are often shocked to discover that expenses for these services often must be paid in full before boarding transportation home, a concern that can be handled by travel health insurance.

"You can go broke just trying to get yourself out of a country if you get sick," said Berger.

Some commercial airlines refuse to carry ailing passengers, leaving private air ambulance as the only alternative.

"Let's say you have someone who gets sick in Cancun, Mexico, and needs to be evacuated back to Miami by air ambulance," said Patricia McAllister, vice president of World Access Services Corp., one of the growing number of companies that provides health care services abroad. "That alone costs about $7,000."

The more exotic the locale, the more challenging the obstacles to care and returning home. McAllister tells the story of two women in their eighties who were cruising the Mediterranean Sea earlier this summer when one experienced a suspected heart attack and developed breathing problems. While trying to minister to her, her companion tripped over a stool and broke her hip. Unequipped to handle these medical problems, the cruise ship diverted to Tangier, Morocco, where the women were dropped off, ailing and unable to speak the language.

But a travel health insurance policy they had purchased with their tickets provided help. Within a day, a medical team from World Access arrived to fly the women and their stretchers 2 1/2 hours to a European hospital for care. Once stabilized, they were brought home to the United States.

A growing number of employers are also offering travel health insurance policies as a benefit to their employees. Just weeks before they left on a trip to Bermuda, Henry Cook, 57, of Haverhill, Mass., and his wife learned that Cook's employer, Schneider Electric, had bought travel health insurance policies for its staff. The purchase paid off when Cook suffered a heart attack during the trip.

His wife called the insurance company, Assist America, and within 15 minutes, it had a doctor on the phone and arranged a conference call between Cook's doctor in Massachusetts and his physician in Bermuda. When it became apparent that Cook needed emergency coronary artery bypass surgery, Assist America sent a medically equipped jet with a doctor and nurse to fly the couple to Boston. The company also paid Cook's $8,000 hospital bill in Bermuda. "I'd recommend the service to anybody who travels," Cook said.

Margaret Sullivan, of New Brunswick, N.J., also learned the value of having travel health insurance when she slipped on an icy sidewalk and broke her ankle in Moscow in 1995. Not only did her travel health insurance pay for the doctor and hospital in Moscow, but it also covered follow-up medical bills at home, including her $100 deductible for her standard medical insurance. "They even paid for the air cast and the cane that I used for six months," said Sullivan, manager of strategic science communication at Rutgers University in New Jersey. "Now if I'm going someplace out of the country, I always buy travel health insurance."


* AARP Fulfillment, 601 E St. NW, Washington, DC 20049. Request free brochure D-16813, "Selecting Medicare Supplemental Insurance", which includes information about travel health insurance.

* International Society of Travel Medicine, P.O. Box 871089, Stone Mountain, GA 30087-0028. Phone: 770-736-7060. Fax: 770-736-6732. Web site: www.istm.org. Provides access to 1,500 health professionals specializing in travel medicine.