Medical/supplemental insurance for India
 

I really should know better considering how many trips we've taken and how many times we've gotten trip insurance. But, lately, we haven't been purchasing it...mostly because we just haven't been able to justify the expense.

But given that India is coming up -- and how much greater the risk for getting ill there is -- I am reconsidering the option this time.

The biggest issue is the cost: it's almost 2x what we normally pay for a trip of this length to anywhere else in the region. I'm guessing the premiums are higher for India because it's universally known that the chances for illness run quite a bit higher there than most places?

Anyway, I started looking at what my insurance covers already and can't tell if it's good or not: foreign claims are obviously considered out-of-network and they will cover up to 80% of eligible expenses (with a $1300 deductible) -- and ER visits are considered 'eligible' so long as you're not admitted for in-patient services...then the ER visit is considered an inpatient benefit and not covered.

I guess the question is: even if an external travel policy is purchased, you're still paying out of pocket upfront, right? So does it just come down to who covers more? Out of pocket costs, I'm assuming are still stiff no matter which path one pursues.

Thanks in advance for the advice. I'm hoping that folks with a ton of experience in this area (Kathie, are you there?) can chime in. I'm not anticipating illness, but I feel I'd be naive not to prepare for it on this particular trip.

I would look at medical evac insurance if you aren't already covered, because you want to be airlifted elsewhere (like Bumrungrad in Bangkok) if something catastrophic occurs. The cheapest and best way to go is with Divers Alert Network (DAN) - it is included in your membership (I think a family membership is $100 per year). Hope this helps.

Do talk with someone at your insurance company. I have a pretty standard Blue Cross/Blue Shield policy that restricts payment to in-network providers. But it still covers urgent care anywhere in the world - and pays the full amount, no deductible, no copays.

So your medical coverage may well be better than you think.

I do think it is always worthwhile to carry med evac - I use DAN membership for mine. It covers the two of us at the family rate of $55 per year.

I did talk to someone -- but perhaps she didn't completely understand what I was asking. But, this begs another question: is a distinction made in India (like the US) between an Urgent Care center and an ER?

Also: isn't healthcare in India (places like Delhi or Mumbai) on par with Western medical care? ...or at least on par with a place like Bumrungrad? I had assumed so...

Some places are, some are not. I would do a bit of research ahead of time. You want to know where you would go rather than trying to research it when one of you is ill.

Urgent care doesn't necessarily mean ER. When Cheryl got sick, I called Bumrungrad and got her an urgent appointment. She was not seen in the ER. Her insurance covered the whole thing, including labs and medications.

I'd look at your policy and I'd call the insurance company back. Good luck!

Not an expert, but just sharing my knowledge.

If you get sick in any large Indian city, you will get pretty good medical care as the doctors are well educated and experienced. Private hospitals are pretty good. By American standards the doctor fee, the hospital stay as well as variety of tests are much, much lower priced than the US.

If you do get sick there, most often a doctor can come to your hotel to see you and guide you.

You should check with your current insurance agency that if you do get sick there and you pay in the Indian rupees, can you be reimbursed in the US.

Of course, you should also check about medical evacuation so that in case you are not happy with the doctors and want to leave for another country or come back home, you can do that without hesitation and too much trouble.

Do share with us whatever you find as many other travelers will face the same dilemma.

While on the subject, make sure you take all sorts of preventive medicines in a little kit. Especially something like Emmodium as most often travelers to India get horrible upset stomachs. Remember to pack hand sanitizers too.

Good Luck and hope you find some more helpful answers from other experienced travelers.

Digressing---a new prime minister was elected in India in May and he is now promoting a "Clean India" campaign asking all citizens and all businesses to take charge and clean up. The country seems to be very enthusiastic at the moment and it seems in the next five years we all should see a much cleaner India. That will give all of us more confidence to travel there and not worry about getting sick.

US citizens have been known to travel to India for medical care because it's so much cheaper.... E.g. For heart surgery. But you do need to be in the right hospital!

Regardless of your medical insurance you definitely want evacuation insurance. I also want repatriation, which DAN does not cover (gets you to the nearest medical facility, but not home). I buy mine through Seven Corners.

Our HMO will reimburse us for some costs. We only carry the DAN evac policy.

Your driver/ facilitator can certainly suggest appropriate expat hospitals. Google American accredited hospitals in India.

If I got sick I would get out of there quick.

Don't forget prevention is the best cure-- no ice anyplace... Bottled water... Only fresh cooked meats... I would not eat seafood... No sushi... NO BUFFETS--NONE... Limit or no fruits...must peel in front of you... NO STREET FOODS....eating is a low priority while traveling in India... I would skip lassies or anything with milk or ice added to it...

Besides no buffets, refuse any food that is not HOT - warm is a danger sign. I've drunk lassi with no ill effect, but take a good look at the premises. Note that you are no safer in a high end hotel - the one time I got sick on my last visit was in the most expensive hotel of the trip.

We MedJet - there's a clause that states one has to be hospitalized to be eligible to be med-evacked.

We ALWAYS get travelers insurance through insuremytrip.com when going to Africa or Asia and parts of Latin America. Insuremytrip is an online broker that allows you to compare plans. It's truly worth a few hundred dollars for peace of mind. Sadly we had to use it for a death in the family and also for a an injury that required us to cancel a trip. We didn't find insurance India to be any more expensive than the other places we go. We always get $1m plus per person for evac to hospital of choice. We also sometimes get 'cancel for work reasons.' We don't usually include airline costs because we use miles so often on vacation...that keeps price down.

If you do need a hospital in India with an illness/injury that doesn't require evacuation, your agent will get you to the right place. My friend injured her knee in Chennai, was hospitalized and got excellent care.

We normally eat street food and don't get sick. But for India we were more careful and took the miracle antibiotic Rifaximin as a preventative because my travel doc told me she had gotten extremely ill in India. Rifaximin is mild and doesn't get absorbed or stay in your system, but prevents traveler's diarrhea. We also avoided meat and fish - that probably helped as well. The first part of my trip report is about Rifaximin:

http://www.fodors.com/community/asia...agra-delhi.cfm

If you decide against the Rifaximin as a preventative, Imodium, as mentioned above, is NOT a preventative. That stops you up, and is usually prescribed after you've been sick for several days. Americans have used 1-2 Pepto Bismol tablets a day safely as a preventative. (For whatever reason, PB is not available in Europe.) I know ex-Peace Corps volunteers who were part of the initial study in Guatemala. If you choose this route, remember that your tongue might turn black!

No buffets? Wow, that would be a real bummer when it comes to the Oberoi's breakfasts. Really?

I rarely eat at buffets, but when I do I am very discriminating. It is true that buffet food in general is more risky as it may be held at an unsafe temperature for prolonged periods. Only you can decide if you want to eat the Oberoi buffet breakfast. My memory of the breakfast in Kolkata was that the foods like eggs were made to order, just breads and fruits and such at the buffet.

Well, maybe stretch it there

I would regard anything non-vegetarian on a buffet with deep suspicion, regardless of the price/status of the hotel.

We did not have any issues with Oberoi breakfasts and I also recall eating at the buffet at the Radisson near the Delhi airport with no ill effects. You can always order a la carte :-)

We survived the Oberoi buffet. I believe Purell was one of the items.

Reading with interest as our trip is in late January. Been thinking about Rifamixinm, have you looked into it yet?

We now know dozens who have taken Rifaximin for India travel with no illness and no side effects. Most were traveling for work, but we took it for 12 days on vacation because our travel doc raved about it - she said that 100% of her patients who take avoid getting sick and 50% who don't take it get some sort of intestinal disturbance. She sees a lot of high profile performers, politicians, deal makers etc. (I know - a little obnoxious, see my trip report..were we important enough for Rifaximin??), but I trusted her advice.

It has been used in the US for years as a treatment for traveler's diarrhea, but has been routinely prescribed in Europe for decades as a preventative for traveler's diarrhea and recently tested and advocated for that by the FDA.

We travel often to Latin America and have never taken it there, so chances are we wouldn't have gotten sick in India. But because we were going for a relatively short time and we love spicy, authentic food, our travel doc convinced us. (We also avoided meat, chicken and fish.) The only downside I can think of is the price. It was outrageous when we took it two years ago even though partly covered by insurance. I think there now is a generic.

Of course, talk to your doc to see if it's right for you.

Re: buffets...I agree with thursday about no meat/chicken/fish from a buffet, even at the Oberoi. I don't remember much about the Oberoi breakfast except that it was a little too westernized and over the top for my tastes.

If any of you are going to Devi Ghar near Udaipur, they will prepare any kind of street food for you using high end ingredients. Just take a photo of the food that looks appealing.

CC, I first learned about Rifaximin from your trip report (which was GREAT and so helpful in planning our upcoming trip).

We always travel with antibiotics Incase we get sick. karen was very sick last trip and in 6 hours after starting abx, and careful hydration she was on the mend.. Even when you are cautious it can happen, and you don't know where you picked up something.

Just back from my longtime doc (who also was a longtime epidemiologist battling all sorts of nasty bugs all over the world prior to forming a practice...and happens to be one of the leading travel docs in LA.) So I trust him implicitly, especially because he's done so much field work in Cambodia, India and Indonesia and knows what he's talking about.

Got all our shots, scripts written and the usual run-down of all the possible risks. The only thing that came up as slightly surprising was that he agreed that, if you can afford Rifaximin, it's a much more effective treatment for TD than Cipro (which apparently is not as effective in India) -- but that it should NOT be taken as a preventative. Not sure if that's just cuz he knows that we're not independently wealthy and could never afford a 3 week supply of it. But he also mentioned that if price is of concern, Azithromycin is also an effective substitute--not as effective, but effective nonetheless.

I can't understand how anyone could ever afford this medication given that 60 pills costs roughly around $1500-$2000. We're going for 3 weeks. That's more than a substantial part of our overall trip cost. Also, as an update to the open question, there is no generic version of Rifaximin currently on the market, unfortunately.

I'm all for miracle cures but a little diarrhea is certainly not the end of the world. Not something I'd be willing to shell out that much money to prevent (even if my doc did recommend it).

So long story short is that we'll probably get a handful of the Rifaximin (6-8 each) for treatment of active TD rather than a ZPack just for its significant efficacy. But since I'd probably need to make as much as the Pitt-Jolies to afford this as a preventative (even if doc recommended it as such), I think I'll just stick with the daily Pepto pill as our preventative for good measure (whether that actually works or not, remains to be seen).

CAVEAT EMPTOR: this is my doc and by no means is this post meant to be a reflection on what others should do. Everyone should consult their own doctors and make decisions for themselves based on their medical history, risk level and specific destinations.

The bugs started developing immunity to Cipro several years ago. I have been taking something else along at least since 2010.

I am not at all enthusiastic about taking pills to prevent something that may well not happen, but I rarely get sick when I travel. My feet, on the other hand....

Hi filmwill, Did you check the cost of the Rifaximin or is that what your doc reported? When we went to India in 2012 it was indeed super expensive, but our insurance paid for most of it. I think our cost was $400 for two weeks.

But in the last year or so the cost has decreased substantially. When our friends went in 2013, although there was no generic version the tablets were down to about $1-$1.50 each. It is also available as a generic in the Boots pharmacy in Heathrow. Here it is advertised on one of the online pharmacies for $.89-$1.27 depending on the quantity purchased:

http://www.inhousepharmacy.biz/p-111...rifaximin.aspx

Our doc (who treats large groups of travelers - film crews, musicians, field workers, business people) suggested Rifaximim because she said 60% of her patients who didn't take it got sick in India, even if they were careful. And 0% of those who took it became ill. We got a second opinion from our internist who agreed. I'm not sure we really needed it because we've been fine in some dicey areas, but because it was noninvasive with zero side effects, I would definitely take it again the next time we go.

I'm getting ready to make the same decision about our February trip, haven't yet checked whether insurance will cover some of the costs. CC, what do you know about this online pharmacy?

I found that pharmacy by random googling, so I can't endorse it. A psychiatrist friend who went with a group of doctors got his for a good price at Costco with a coupon. We didn't agonize about the decision because so many of our friends had taken it and our doctor was so enthusiastic about the wonders of Rifaximin (she had gotten sick in India). But, as filmwill said, you should trust your physician for medical advice.

OK, apparently there are some organizations that verify online pharmacies. I will do some more digging and probably order that way if our insurance is not covering it. Looks like about $1 per pill based on generic version available in Canada.

Sounds like a deal!

We got trip insurance from Insuremytrip, for $414 (covered both of us) for a 25-day trip this past Feb. It gave us $50K in medical, $100K medical evacuation, plus cancellation, interruption, etc.

We ate yogurt every morning we were in India (although we also eat yogurt fairly often at home). Our guides and driver were VERY specific about places they recommended for us to eat. We ventured out on our own once and a while, but still ate only at recommended places. We avoided street food, although by the time we got to Udaipur, we were tempted but did not succumb. (We really were unimpressed with the hotel food in Udaipur, but the two restaurants we would have gone to instead were totally booked.) We never got sick, once. We ate at breakfast buffets, or had food cooked to order for breakfast at all our hotels. Oh, and the lady who gave us a "cookery class" in Delhi and her husband also had suggestions for us to follow. I've never felt so taken care of on any of our travels!

We ate seafood in Kerala. It was fantastic. Tried mutton or chicken when offered non-veggie options, and preferred chicken most of the time. Mutton is as likely to be goat as it is lamb. We did learn, fairly early in our trip, that the best drink to have was beer or bottled water. (Although in Kerala, we fell in love with lemonade with ginger.)

Kerala is setting itself up as a Medical Tourism destination. (There will billboards to that effect all the way in from the airport and back.) Our biggest medical "issue" was insect bites in Kerala. My husband, for the 1st time in our 38 years together, was attacked by mosquitos (instead of me). DO take along benedryl.

Oh - and in Delhi, there IS a restaurant "Dhaba" at Claridges Hotel, which prepares "high end" truck stop/highway food. It is exceptionally good.

We got Rifaximin last year from our local drug store in NYC with no problem and only our usual co-pay. We have very good prescription insurance, so maybe that was the reason. We ended up not taking it but we were very, very careful about our food. But we did eat Oberoi buffets when they had them. We never once had any GI problems in three weeks in India.
Just as important as evacuation insurance is cancellation insurance once you reach "a certain age". We have had to cancel trips due to pretrip problems which is big problem if you have had to repay without refunds.
Good news...if you bought your airline tickets with FF points and needed to return early, the rebooking fee is very small compared to last minute tickets especially Business. We did this last June with BA and they found seats for us overnight.

For anyone who has used rifamixin as a preventive, can you tell me what dosage you were given? I've spoken with 2 different doctors who don't know about its use for preventing TD, so I'd like to give them a nudge. Thanks.

I've had to go to Canada to get reasonably priced drugs after losing my US health insurance, and have found a company called Canadian Pharmacy King to be very cost effective. Just checked out their price for generic Rifaximin (and it comes from India!!!) and 200mg with 100 qty is only $50….the dosage if you get TD is 200 mg/ 3X day for 3 days….so you'll have a lot to share with fellow travelers! There are various reports about it's efficacy for prevention….so check this out online.

FYI, we always get Medjet Assist for medical evacuation….there's a discount for AARP members too.

Agreed...everything is more affordable outside the US! ;)

As a follow-up, we ended up getting it but only as a treatment and not a preventative.

Our prescription insurance (which is amazing--wish our regular medical plan was as good!) covered a ton of the cost.

To be clear, we got 18 pills (6 days of treatment x 3 pills/day). The retail cost of this was close to $700! Luckily, the cost ended up being $55 after insurance kicked in.

But my doc was pretty clear about the fact that he only felt strongly about its efficacy as a treatment for TD (vs as a preventative). Again, that's just my doc...and the way we're going about it.

Rifaximin is an antibiotic that fights intestinal bacterial infection. Its available EVERYWHERE in India with different Brand names like RCIFAX, Rifaximin, RIFAGUT, RIXMIN & TORFIX.

Each tablet of 200mg will cost u around INR 10.00 eachI just checked with my friend who is MD in India.

fillwill, Congrats on your great prescription plan. We're there with you...Still have our stockpiled supply of Tamiflu from the SARS scare of '07.

FromDC, No surprise that's Rifaximin is available in India! The dosage we were prescribed was 2 x 200 mg tablets (2 a day). We did not take it on travel days, just on the ground.

I recently saw my travel doc about something else and she sent me a link about a German study that was conducted over 4 years in India and SE Asia.

http://www.thelancet.com/journals/la...221-4/abstract

She said Rifaximin is now routinely prescribed as a preventative for European business travelers. She's such a fan that I asked if she was getting a kickback from Big Pharma, but she said that many of her patients get the generic version online. She's so enthusiastic, she reported, because she still has a 100% success rate of prevention among her patients, with no side effects. (Again, just one opinion - everybody should check with his or her own doc.)