Posted on behalf of RoRC, Jonathan Lloyd

MEDICAL INSURANCE COVER WHILE CRUISING IN THE USA
A recent injury sustained while participating in the OCC Southern New England Cruise this summer has highlighted a number of issues associated with medical insurance cover while cruising in US waters, which members, who are not US citizens, might wish to be aware of when arranging such cover. The first is that your annual worldwide travel/medical insurance may not cover you while cruising in US waters and additional cover together with an additional premium may be required. This was the case with our Topsail Sailors Gold policy. We had to take out additional cover at a cost of GBP 350.
The second issue is one of duration. When arranging the additional cover the maximum period of cover that Topsail’s underwriters would provide us was 5.5 months. Given that most international cruisers visiting the USA are extended a visa of 6 months duration and sometimes longer this limitation is somewhat inconvenient. In the case of Topsail a recent change of underwriters has further exacerbated this situation, as the maximum duration of a visit has been reduced to 89 consecutive days.
The third issue is that a claim on the policy as a result of an injury sustained while in country could well involve repatriation rather than treatment in country. Most if not all travel insurance policies have a clause in their terms and conditions, which allows the insurer to exercise this option. In many cases around the world this might arise as the country where the injury or illness occurs cannot provide the requisite standard of medical treatment and care. However, in the case of the USA this option is more likely to be exercised as a result of the very high cost of medical care in the USA. If the injury or illness is not life threatening or requires immediate attention to prevent further deterioration and the patient can be certified “fit to fly”, then repatriation rather than in country treatment is the most likely option.
In this regard it should be noted that repatriation raises a number of issues of its own. In the case of Topsail once you have been repatriated either you or your national health care system (the NHS in the case of the UK) are responsible for your medical treatment and the costs associated with it. You are also responsible for the travel and accommodation costs associated with your treatment while back home. Given that many members may have sold their cars or either sold or rented out their house before setting off on a circumnavigation or long term cruise, this could involve substantial costs, especially if the treatment is prolonged, which have not been allowed or budgeted for, in the event that family or friends are unable to provide.
It should also be noted that in the case of UK citizens that once you have been out of the country for a period of longer than 3 months that you are no longer entitled to free health care! While most NHS hospitals ignore this regulation; particularly if you are still registered with your doctor or GP, they are not obliged to do so and in future, if pressures on the NHS budget increase more hospitals may decide to charge for treatment, particularly if you are flying in for it and are no longer registered with your local doctor or GP.
A further issue arising from repatriation is the cost associated with leaving your yacht in the USA during your repatriation as it will not covered by your travel/medical insurance. This will almost certainly be expensive whether you opt for a marina, mooring buoy or hard standing. The operating budgets of most long term cruisers do not allow for spending weeks and months on end in a marina et cetera, as a considerable amount of time is normally spent at anchor, so this situation may not have been budgeted for.
Based on our experience I would urge OCC members, who are not US citizens, to look very carefully at the potential implications and limitations of the medical cover that is provided by their travel insurance while cruising in the USA, so that potential outcomes in the event of injury or serious illness can be planned and budgeted for in advance especially if repatriation is likely to be involved.
For insurers such as Topsail and their underwriters I would urge them to extend the standard period of cover provided from 89 days to 6 months, so that it matches the standard period extended to international cruisers by the US Immigration Service. I appreciate that such a move could involve an increase in premium, but this would have to be set against the cost of having to leave and re-enter the USA necessitated by current policy terms. I would also ask them to consider an opt out clause in respect of repatriation. Once the policy excess is set against the cost of an economy airfare to and from the USA the policy holder is already bearing a very significant proportion of the cost and thus may prefer to insure themselves in this eventuality. This would have the benefit of focusing the policy cover on treatment in the USA where this is medically essential.

Bill Balme