How health insurance works when you get care abroad

When you get care in another country, three questions decide who pays: which kind of cover you hold, whether the treatment was planned, and whether the hospital bills your insurer or you.

These are the kinds of cover you are likely to meet:

• Your home cover. Public systems and domestic insurance are built for care at home. Original Medicare, for example, rarely pays for care outside the United States.
• A European health card (the EHIC, or the UK's GHIC). It gives you medically necessary state healthcare on the same terms as a local resident.
• Travel insurance. It covers the unexpected: an accident or a sudden illness on a trip.
• International health insurance, often called IPMI. It is built for people living abroad, and it follows you across borders.
• Medical evacuation cover. It pays to move you to a suitable hospital, or home.
• Complication cover. A narrower policy for problems after surgery you pay for yourself.

The biggest line runs between care you planned and care you did not. A GHIC or EHIC is for treatment that cannot reasonably wait until you are home. It leaves out private clinics, planned treatment and the flight home. Travel insurance draws the same line: the Association of British Insurers says a standard policy leaves out travelling for treatment, and that you need a specialist policy for it.

If you live in the EU and plan treatment in another EU country, you have two routes. With prior approval on an S2 form, your health insurer pays a public provider directly, and you pay only the local co-payments. Or you pay the clinic yourself, a private one included, and claim back up to what the same treatment would cost at home. The difference is yours to pay. Some treatments need approval before you go, so ask your insurer before you book.

If you are on Original Medicare, plan to pay for care abroad yourself. Some Medigap plans pay 80% of emergency care abroad after a $250 yearly deductible, up to a lifetime limit of $50,000, for care that begins in the first 60 days of a trip.

International health insurance handles conditions you already have in one of two ways. With full medical underwriting, you declare your history when you apply, and the insurer tells you from day one what it excludes. With a moratorium, conditions you had in the years before you joined, often five, are left out until you go a set period without symptoms or treatment, often two years. Answer every health question in full. In some countries, Mexico among them, a missing or inaccurate answer lets the insurer cancel the policy.

Then there is the question of who pays the hospital. When your insurer has an agreement with it, the insurer can pay directly, usually after approving the treatment first. Otherwise you pay and claim it back, and the claim stands or falls on an itemised bill and a medical report. Our piece on direct billing and claiming it back covers that paperwork in detail.

To pay a claim, your insurer reads what the claim needs: the medical report, the diagnosis and the itemised bill. If you pay for a planned procedure yourself, no insurer is involved at all. Some countries write the insurer's access into law: in the UAE, insurers checking a claim are among the few who may see your health data without your consent.

Before you book treatment abroad:

• Ask your insurer, in writing, whether the treatment is covered abroad and at which hospitals.
• Ask whether you need approval before treatment, and keep the approval.
• Ask the hospital whether it bills your insurer directly.
• Check how your policy treats conditions you already have.
• For planned surgery you pay for yourself, look at complication cover.
• Keep the medical report and the itemised bill from every visit. A claim often needs both.

Insurance pays on paper. Keep every report, bill and approval in one place on your phone, ready for the claim and for the next doctor who needs your history.