Travel insurance is short-term insurance available specifically against travel-related emergencies and expenses. International travelers will almost always want to obtain travel insurance because it covers 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).
This article is a general guide to travel insurance policies, including some possible terms but is not a substitute for careful review of the specific policy you may purchase. Travel insurance policies differ markedly in their terms and conditions.
Why it's needed
Travelers sometimes feel they can skip being insured if they're not carrying valuables, have changeable/refundable tickets, and can afford to be stranded at their destination for a while. There are four main reasons that may not be 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 public health care to tourists, but it may not be up to your standards.
- Medical evacuation back home or to the nearest suitable hospital can cost well over US$100,000 per evacuation. Even if you're covered abroad (per above), it's very unlikely to get you back home if you are seriously injured beyond what can be handled locally or requires a lengthy recovery.
- 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.
- Travel at short notice can be expensive. You got an extremely good deal on an airline fare well in advance. Unfortunately, in the middle of your vacation a family member was hospitalized or passed away. Now, it's going to cost many times what you originally paid to get back home, in addition to forfeiting the remainder of your stay.
These situations, plus many others, are explained in depth below.
How to buy
You can obtain travel insurance 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.
You purchase travel insurance for international trips through an insurer in your country of residence, which means 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 if a family member became very ill (these are assumed to be the same country).
Some credit card companies insure any trip you take as long as you buy the tickets on a particular credit card. 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 personal holiday, check the cover: usually personal holidays on the side 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 of your cover. Credit card insurance deals, for example, often offer just basic cover, and may be invalidated for travelers who paid travel deposits in cash rather than using the card.
If 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 on-line search. But take care that the company has a good reputation, e.g., from friends/family that 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. Most major travel insurers offer such policies. Large businesses often purchase such insurance for their key or frequent travellers.
- 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 better odds than this.
- Cruise insurance (though most cruises should be insured, but not with this type of coverage). Temptingly modest in cost, many such policies cover few risks at very modest levels (rarely medical care or Medevac), only during your cruise and 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, e.g., troubles before the trip starts, flying to/from embarkation-debarkation port(s). 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 a flight ticket online. You will usually get better value with a more comprehensive policy.
When to buy
You will get the best value out of 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 may develop between booking your trip and buying your travel insurance will be considered pre-existing conditions. Any natural disaster or outbreak of violence at your destination that occurs before you purchase your policy won't be able to be the source of a claim.
You can purchase travel insurance as late as your day of departure, although if you have pre-existing conditions that need to be evaluated and accepted by the insurance company you may be out of luck if you leave it too late.
The are a number of factors that generally influence the cost of a policy.
- Number of travellers. Some travel insurers will cover dependants and families at a reduced cost.
- Age. Once you reach 55 years of age, premiums can rise. At older ages, some companies refuse insurance entirely or charge a significant premium.
- Duration. Policies are general sold for date ranges. For example 7 days, 15 days, 30 days, 90 days.
- Destination region. The most exotic destinations can often be cheaper than destinations like North America, where health costs are much higher.
- Pre-existing conditions. These are assessed by the insurance company, and result in additional premium policy refusal.
- Additional cover. How much do you need to cover a 24-hour delay?
- 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, they may not honour any claim if you do.
Making a 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 companion(s) cannot talk to the insurer first. As above, your insurer may have fully-effective, alternate means to arrange what you need and avoid costs. They won't pay (or pay fully) if evacuation is otherwise self-arranged. In case of unavoidable self-arranged evacuation, go no further than is necessary to obtain proper care, not (in most cases) all the way home.
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. You need to ask for refunds from providers for all or part of the costs of tours, lodging, etc., that you had to cancel. You can only claim 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.
If you are incapacitated, your travel companions or contacts at home will need to deal with the insurer; make sure they have contact details. Many 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 be useful information.
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 plus a day or two for delays), whether it covers what you need, 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 should be able to find separate coverage for each. If you need many types of coverage, you'll likely want an integrated policy that offers many kinds of "protection", some of which you may not need. But its cost is likely to be significantly better than separately buying all that you need.
Medical expenses coverage
Usually, whatever standard health insurance you have will pay only claims for medical care in your country of residence. Also, even if your medical care is usually paid for by your government, this usually won't extend to medical costs incurred in other countries. Some countries with universal healthcare (such as Canada, UK, Australia) might have reciprocal agreements with other countries with similar health care systems. 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 covers international medical expenses, you may have to pay all medical expenses incurred while traveling out of pocket or through help from your insurer; in many cases, quality medical care can be very expensive. Therefore, all international travelers should be certain that they have medical coverage via a travel insurance policy that covers medical expenses they unexpectedly incur on their trip. Unless you'll not be far from home, you should also opt for medical evacuation coverage discussed below.
Some hospitals may only admit you if you 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.
Coverage for medical care does not automatically include medical evacuation.
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 high 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 pre-existing conditions excluded. This is obviously undesirable if your existing condition causes you significant problems or leaves you at risk. Some policies will cover pre-existing conditions if you buy coverage within a short time after booking your travel, perhaps 24–48 hours, others for up to two weeks. For many people, it's worth some research to find such policies. Failing that, if even possible to have your pre-existing condition covered, you may need to undergo a medical assessment and pay an extra premium for medical insurance or an extra-cost option in the travel policy.
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 hospitalised due to the pregnancy, coverage may be denied altogether. If you have a child born overseas, care of the child will not be covered by your policy.
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 include 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
A medical evacuation is often a chartered trip (usually a flight) for a patient who is not well enough to return home by other means 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. On-balance, the cost of coverage is not terribly great.
Although some people have worldwide medical coverage as part of their everyday health insurance, it virtually NEVER comes with international medical evacuation. Even if you are willing to forgo all other types of international travel-related insurance, no one should ignore evacuation coverage.
There are multiple 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 (after hospitalization), 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 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, to later be evacuated to your home country. The total price for "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 "medi-evac" 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.
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.
Travel insurance will often cover expenses related to unexpected cancellations by your carrier or destination providers, e.g., costs associated with a canceled flight, including accommodation, 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 things like your disappointment at your holiday being cancelled.
More expensive policies may also cover your own discretionary cancellations if there is an exceptional circumstance: for example, there are some travel insurance policies that will pay you the cost of your ski lift tickets if a resort has shut due to lack of snow.
There are always a raft of conditions about acceptable and unacceptable cancellations. Some examples of troublesome situations:
- 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 partner's death might not be;
- 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 from where you departed, you'll have to pay any difference in fare, if higher. Upon reunion, your policy will have terminated, and you're on your own.
- Many policies cover cancellations or delays due to terrorist activities, but very few, if any, will cover these due to the mere threat of terrorist activity;
- 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 polices, it only covers those of travel providers--never your own personal or self-employed business bankruptcy.)
- 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.
- Some policies cover cancellations if a destination has recently become unsafe due to either a declaration of war or a recommendation by your government to cancel travel to a particular area; others do not cover this.
Take care with cancellation waivers offered by tour packagers or operators and travel packagers/consolidators who've arranged your travel. If you or they must cancel, such waivers typically cover only what you've paid them, and not other related commitments you've made. They also will have no value if the reason for cancellation is bankruptcy of the packager/operator.
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 will pay at least 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 h left of the holiday anyway!).
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 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 the with 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 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 cars and other vehicles will have limited coverage, as will theft of, and particularly simple loss of, cash, money orders, travelers checks and credit cards.
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 dependants may have their inheritance greatly reduced or canceled.
There may additionally be a lump sum benefit to your next of kin, although seldom anything like the amount of money that a life insurance policy might pay.
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:
- Riding a motorbike or scooter, although common in some south-east Asian 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, that lead to injury often aren't covered. This can including flying when not on scheduled commercial flight.
- 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.
- Sexually transmitted diseases, including HIV.
- Illegal activities
- Accidents while under the influence of drugs or alcohol
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.
Travel insurance becomes increasingly difficult to get after age 55, with your age alone being considered something of a pre-existing condition. The precise cutoff for receiving insurance without an addition 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.
Some policies have an excess amount (also called a deductible), which is deducted from any claim you make, so that you will be paid the amount of the claim minus the policy's excess. In general, the lower the deductible, the higher the insurance premium. Travel insurance with a $5000 deductible can be as little as $10/month: that means that it will not cover 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.
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 presently 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.
Example tables of coverage
In concert with the above discussions, these tables reflect coverages under three kinds of multi-coverage policies currently offered by one reputable insurer. 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.
|Feature||Basic Cvg||Moderate Cvg||Deluxe Cvg|
|Emergency accident & sickness medical expense (50% deductible)||10,000||50,000||150,000|
|Pre-existing medical condition||None||Included||Included|
|Baggage & personal effects ($50 deductible)||750||1,000||2,500|
|Missed connection/itinerary change||None||500||750|
|Emergency evacuation, medically necessary repatriation & repatriation of remains||100,000||500,000||1,000,000|
|Renter’s collision insurance (for liability, optional extra cost)||50,000 for $7/day||50,000 for $7/day||50,000 included|
|Accidental death & dismemberment (AD&D)||None||10,000||25,000|
|AD&D air only||Optional||Optional||100,000|
|Children under 17||One free per covered adult||All free||All free|
|Cancel for any reason||None||75% of trip cost||75% of trip cost|
|Medical & legal assistance||Included||Included||Included|
|Political evacuation||None||Included with optional Medical||Included|
|Lost baggage retrieval||Included||Included||Included|
|Passport replacement/visa info||Included||Included||Included|
|ID/credit recovery assistance||None||Included||Included|
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.
|Feature||Basic Cvg||Moderate Cvg||Deluxe Cvg|
|Pre-existing medical condition||None||Covered||Covered|
|Bankruptcy (of travel provider)||None||Covered||Covered|
|Weather (hurricane, etc.)||Covered||Covered||Covered|
|Accident enroute to destination(s)||Covered||Covered||Covered|
|Natural disaster at destination||Covered||Covered||Covered|
|Evacuation at destination||None||Covered||Covered|
|School year extension||None||Covered||Covered|
|Jury duty (non-postponable)||Covered||Covered||Covered|
|Job loss (w/min. time employed)||Covered||Covered||Covered|
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...almost always except for pre-existing conditions.
As discussed above, look at the details thoroughly, especially if contemplating a trip to distant lands. Once you have done so, have taken your trip and were happy with the insurer, for a subsequent big trip you may only need to quickly consider their same policy and options before buying it.
Many insurers specifically exclude travel to countries and areas known to be extremely dangerous. As a rough guide, if the US State Department or your own country's government recommends against any travel to a particular country or area, you will find it difficult to get insurance coverage. As always, check the terms carefully, and if you are travelling to an unstable region, keep an eye on the travel warnings for any updates that might invalidate your insurance.
Make and carry copies of your policy and your insurer's contact details with you. Have another copy in your luggage or online. Also give policy/contact copies to traveling companions and relatives or friends at home willing to help if needed. If you are incapacitated, someone else will have to deal with the insurance company on your behalf. They must know with whom, and how you are insured (if 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.