Medical evacuation and repatriation cover

Evacuation is the benefit you hope never to use and cannot afford to misread. IPMIBenefits explains the difference between evacuation and repatriation, who decides, what is paid and where the gaps are.

Evacuation, repatriation and the benefits around them

These words are used loosely in brochures, so start with what each means on an international private medical insurance (IPMI) plan.

Medical evacuation

Transport to the nearest appropriate facility when the treatment you need is not available locally. It is a medical decision, triggered by an emergency or a serious condition, and the destination is usually the nearest place that can treat you, not the place you would prefer.

Medical repatriation

Transport to your home country, or sometimes your country of residence, for treatment or to recover. Some plans include it with evacuation; others sell it as an option, or restrict it to cases where the insurer agrees it is medically appropriate.

Return of remains

Transport of the body home after death abroad, or local burial costs. Usually included with evacuation, with a fixed limit.

Companion and family benefits

Travel and accommodation for a companion to accompany an evacuated patient, or for a parent to stay with a hospitalised child. Expatriate Healthcare lists companion travel and accommodation with its evacuation benefit.

Local ambulance

Road ambulance to hospital in an emergency. Separate from evacuation and often in the core. IPH Emerald publishes local ambulance alongside evacuation and repatriation on all three of its levels.

Evacuation is not a ticket home when you are ill. The insurer's assistance team decides whether evacuation is medically necessary, where you go and how you travel. A patient who can be treated adequately where they are will usually be treated there.

How insurers structure evacuation cover

Evacuation appears in three structures across the insurers IPMIBenefits compares.

• In the core on every plan. Expatriate Healthcare includes emergency medical transport on all four of its plans at full refund. APRIL International includes medical evacuation and repatriation on all four published levels. Now Health SimpleCare CORE covers evacuation and repatriation alongside inpatient treatment. Bupa Global and AXA Global Healthcare both list evacuation and repatriation among their core benefits.
• As an optional module. Cigna Global sells International Evacuation and Crisis Assistance Plus as an optional module. HCI Nimbl lists assistance and evacuation as an optional module, with benefits subject to the selected core cap.
• Basic in the core, extended as an option. Now Health WorldCare lists extended evacuation and repatriation as an option on every level, on top of the standard benefit.

Where it is optional, leaving it out is a real saving on paper and a real gap in practice. Where it is included, the differences are in the limit, in whether repatriation to your home country is covered, and in whether the insurer's assistance company or your own choice decides the destination.

Triggers, approval, limits and the conditions that apply

Evacuation is the benefit with the most conditions attached, and most of them are sensible once you know why they exist.

• Medical necessity. The insurer's medical team must agree that adequate treatment is not available locally and that moving you is safe. This is the trigger, not the severity of the illness alone.
• Prior approval. Evacuation must be arranged through the insurer's assistance line. A flight you book yourself is rarely reimbursed. Optimum Global asks members to contact it as soon as possible in an emergency, ideally within 24 hours of admission; Allianz Care requires notification within 48 hours of an emergency admission.
• Nearest appropriate facility. The destination is the closest place that can treat you. Repatriation home instead is covered only where the plan includes it and the insurer agrees.
• Mode of transport. Air ambulance, scheduled flight with a medical escort, or ground transport, as the medical team decides. Air ambulance is not automatic.
• Limits. Evacuation may be paid in full or up to a stated maximum. Return of remains and companion benefits almost always have fixed limits.
• Return journey. Some plans pay for the trip back to your country of residence after treatment; others do not. Check.
• Area of cover. Evacuation applies within your area of cover and, on many plans, during short trips outside it for emergencies only. HCI Nimbl, for example, includes a limited period of emergency treatment outside the selected area; APRIL International describes worldwide cover for accidents and emergencies during trips up to a stated length.

Evacuation rarely has a waiting period, but it is subject to the general exclusions. Travel against medical advice, injuries from excluded activities and conditions the insurer has excluded can all take an evacuation outside the cover.

What to check in the table of benefits

Evacuation, underwriting and pre-existing conditions

Evacuation is only payable for a condition the plan covers. If a condition is excluded at underwriting, an emergency arising from it is excluded too, and so is the flight. This catches people out: a heart condition excluded under full medical underwriting means a cardiac emergency abroad is not evacuated at the insurer's expense, even though evacuation is in the plan. Under a moratorium the same applies until the symptom-free period has run.

Evacuation itself is not underwritten separately, and it does not carry the waiting periods that dental or maternity do. What changes between applicants is the list of excluded conditions, and that list defines what can be evacuated. If you have an existing condition, read your exclusions with evacuation in mind, and consider whether switching on continued personal medical exclusions preserves cover you already hold. The pre-existing conditions guide explains the options.

Common mistakes with evacuation cover

• Leaving the evacuation module out to save money while living far from specialist care.
• Arranging a flight privately and expecting to be reimbursed.
• Expecting to be flown home when the plan covers only the nearest appropriate facility.
• Assuming air ambulance is standard when the insurer decides the mode of transport.
• Not telling the insurer within the notification window after an emergency admission.
• Forgetting that an excluded condition cannot be evacuated under the plan.

Evacuation and repatriation are easy to compare once you know the questions: included or optional, nearest facility or home, paid in full or limited, and who decides. Nomi can show those terms for every plan it quotes. Read it with the cancer care and chronic conditions pages, because serious illness abroad is where the three meet. The benefits guide places evacuation among the other core benefits.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to an experienced broker.