In sixty-four days I will be packing my bag (yes, just the one) and heading to the airport to begin an epic eight-month trip that will take me from Taiwan to Turkey and then south to Sri Lanka and beyond.
Taking an eight-month trip around the world requires a lot of planning. I had to make a plan to take the time off work (I actually put in the request more than four years ago!), I had to make sure I would have enough money (you can read about how I deferred my salary for more on how I saved more than $75,000 for this trip!) and I had to find someone to sublet my condo while I am away (still working on that…).
Perhaps most importantly, I also had to make sure that I would have comprehensive, reliable, affordable health care and health insurance while I was away. There are a lot of areas of life where I’m willing to go with the flow, but travel health is not one of those areas. It has always been important to me to know that I’m in the best possible health before I leave for a trip, and that I am covered in case I have a health emergency while I’m away. These are the seven steps that you should take before any long trip to make sure you stay healthy from the day you depart until the day you get home…
#1 – Extend Your Government Health Coverage (If Applicable)
About three months before I departed for my sabbatical, I started to research travel health insurance policies. I quickly discovered that almost every travel health insurance company required Canadian policyholders (like me!) to maintain their government-provided provincial health insurance coverage.
“No big deal,” I thought. “I’ve been covered by my provincial health policy for almost fifteen years.”
STOP RIGHT THERE!
I was completely wrong! My provincial health insurance coverage is reliable (and free!), but the coverage automatically ends after you spend seven months out of the province. Since my trip was going to be eight months, this would have left me without any kind of health insurance – at all – for the last thirty days of my trip.
In a panic, I started searching through the deepest, darkest and most hidden pages of the government’s health care website, until I found a small section about extended absences. It said that I may be able to extend my provincial policy if I’m away for more than seven months, and to contact their offices before my departure.
The next day I called the provincial health insurance office and spoke to a representative. I explained the situation: I was taking a sabbatical from work but had a scheduled return date eight months after my departure, and I would be maintaining my primary residence in Canada while I was away.
The agent asked me a few questions and then confirmed that they could extend my provincial health care coverage through the duration of my sabbatical. They asked me to fax in a letter from my employer that confirmed the date I would return to work, and said that unless I heard otherwise I’d be good to go for the full eight months.
If you’re not from Canada, this may not apply. I did some mock applications from travel insurance by pretending to be from the USA and from the UK, and this requirement was not mentioned during the booking process when I set my residency to those countries.
#2 – Purchase a Travel Health Insurance Plan
You need to get your national or provincial health care coverage sorted out before you choose a long-term travel health insurance plan, because whether or not you have that coverage will impact the type of travel health insurance policies that you can buy and how much you’ll have to pay.
My first step was checking with my credit card companies. I have an American Express card which I love – Canadian travelers, if you get referred by another cardholder (like me!) you’ll receive a sign-up bonus with enough AmEx points to convert to 25,000 Aeroplan points. This is enough for a return flight anywhere in Canada, and to much of the USA as well! Since the annual fee is only $120, I think it’s a great deal. If you’re interested, you can use my link to sign up and get the bonus points. You’ll also get access to the AmEx travel portal, which is surprisingly good for booking normal airplane tickets. I recently booked a flight from Tashkent to New Delhi on Uzbekistan Airways, and AmEx offered the best all-inclusive rate of any booking site I could find (including the airline). I also have a back-up Mastercard, which I only use when a business doesn’t accept American Express.
Anyways, although my credit cards both offer great coverage for shorter trips and travel that I book directly through them, they didn’t have competitive pricing for an eight-month, around-the-world backpacking trip.
Next, I reached out to my other insurance providers. I use one company for my home insurance, and a second company for my auto insurance. Neither company offered any travel heath insurance plans that cover cover an eight-month trip.
So, I turned to the internet. In all of my years of reading travel blogs to get travel advice, one insurance company’s name kept coming up again and again: World Nomads. I gave them a quick phone call to discuss some specific information about my situation and to make sure I understood their terms and conditions. They answered my questions and didn’t pressure me to make a purchase over the phone, so I took a few weeks to mull it over before going back to World Nomads and hitting “purchase”.
At the time I write this, I still haven’t left home and I haven’t had to use my World Nomads travel insurance. In fact, the best case scenario is that I never have to use it at all. But, if I do end up needing medical care during my sabbatical, I will report back about the process of submitting a travel medical insurance claim with World Nomads. Until then, you can get an immediate quote for your own travel insurance with World Nomads. (Hint: Set your destination to Worldwide if you’ll be visiting lots of countries or want flexibility in your itinerary!)
#3 – Research the Health Concerns in the Destinations You Plan to Visit
Once, I visited my family doctor before a trip to Roatan, Honduras. I visited her to ask for the same anti-malarial medication I had taken on my previous trips, as prescribed by a local travel doctor. Her response?
“Is Honduras in India?”
After that, I changed my approach. Generally, I would just not bother going to the doctor before my normal trips (ranging from two weeks to two months). How could I trust someone who thought Honduras was in India to give me accurate advice about anything, much less travel health?
However, when I went to ride the Trans-Siberian Railway, I thought it might be good to consult a doctor before visiting the far east of Siberia. With that in mind, I booked an appointment at a for-profit travel medicine clinic (the only kind we have in my region of Canada – travel medical services aren’t covered by our provincial health plan). Here’s how that worked out:
In other words, I’ve kind of lost trust in medical professionals in general when it comes to travel, especially when it comes to travel beyond the most popular tourist destinations and all-inclusive resorts. Still, I decided to book an appointment at a travel medical clinic before my upcoming eight-month sabbatical. Before I went to the clinic, though, I did my own online research so that I would know what to expect. I recommend the following websites for travel health information:
- Fit For Travel from the National Health Service in the UK – general and destination-specific advice
- Travelers’ Health from the Center for Disease Control in the USA – general and destination-specific advice
- Smart Traveller from the Australian Government – general and destination-specific advice, especially for Southeast Asia
- International Travel and Health from the World Health Organization – for the most up-to-date information about current outbreaks and vaccine recommendations
I often check several of those sites to get a wider impression of the recommendations particular to my region of the world. Then, I check the Drug Information Number (DIN) for the recommended medications and vaccinations to see what is covered by my employer’s health insurance plan. I believe that a DIN is equivalent to a National Drug Code (NDC) in the USA, but the actual numbers themselves are different in each country.
If the DIN or NDC isn’t available on the website for the travel medical clinic, you can call them before the appointment to request that information (just tell them it’s for insurance purposes). There are some websites that list common travel medicine DINs in Canada, including this one and this one. With the DIN in hand, my regular insurance company’s website allows me to search for any drug’s DIN and find out whether or not the cost is covered. Knowing this before I go to the travel medical clinic helps me make smart decisions about my health and finances. For example, I always get all of the required vaccinations, but if a vaccination or medication is recommended as “maybe” “helpful”, and I know it costs $300, and I know my insurance plan doesn’t cover it, I might choose not to get that particular vaccination or medication.
#4 – Visit a Travel Health Clinic
It is recommended that you make your appointment at a travel health clinic at least two months before your anticipated date of departure. Since some vaccinations are administered in two or three doses, this usually gives you enough time to get all your immunizations before you leave.
When you attend your appointment, come prepared with all of the information that the doctor will need. You should bring:
- Valid photo ID
- Your insurance details
- Your vaccination records
- Names and dosages of all medication you’re currently taking
- A list of where you plan to travel, and when (since some travel health threats are seasonal)
- A completed intake form (if there is one on the clinic’s website)
Your travel health consultation might be with any number of different medical professionals, including a registered nurse, a registered pharmacist or an actual medical doctor. Either way, they should be specialized in travel medicine, they should have expert knowledge about travel health conditions and concerns, and they should have access to a database of information for medical professionals who work with travelers.
My most recent travel health consultation wasn’t as disappointing as the last few I mentioned above. It was with a registered pharmacist who specialized in travel medicine and worked under the supervision of an MD. She looked at my rough itinerary, identified the highest risk diseases in the highest risk areas, and offered me a recommended treatment plan that included vaccinations, prescription medications and risk-avoidance behaviors. Since I would be visiting more than fifteen different countries she didn’t print off destination-specific reports for me, but instead provided me with malaria maps that showed the highest-risk areas I would be visiting.
#5 – Get All Your Travel Health Vaccinations
I rarely need any kind of special vaccinations before a big trip because I always stay on top of my normal vaccination schedule, and I keep records of all the vaccinations I received (stamped by the medical professional who administers them).
If you are behind on your regular vaccinations, or have spotty vaccination records, you may need to update your standard vaccinations before you go away. A lot of regular vaccinations can be administered at your local public health clinic or through your family doctor, and there shouldn’t be a cost associated with them.
For travel-specific vaccinations, like Japanese Encephalitis or Yellow Fever, you’ll probably need to get them done at the travel medical clinic, or via a referral from the clinic. Since some of these vaccinations need to be administered as a series, over the course of several weeks, it’s really important that you book your appointment at the travel health clinic at least two months before you depart for your big trip.
For my upcoming trip, I booked in at the travel health clinic exactly two months before my departure. During the consultation, the travel health pharmacist recommended that due to the destinations I’ll be visiting and the duration of my trip, I should finally get some of the vaccines I’d always put off – namely, rabies and Japanese encephalitis. The rabies vaccine would be administered over three doses (day 0, 7 and 28) and the Japanese encephalitis would be administered in two doses (day 0 and 28). As well, I needed an updated typhoid shot (just one dose).
So, I rolled up my sleeves and pulled down my pants, because I needed three vaccines and none of them could share a limb. I got one shot in each bicep and and one in my upper thigh. There was no pain during the actual vaccination process, but I did notice that the typhoid shot left my arm with a dull ache for the rest of the day. On my way out of the clinic they asked me to wait at reception for ten minutes to make sure there were no adverse reactions, and during this time I also scheduled the appointments for the second and third doses.
My employer’s health insurance covers the cost of all of my travel vaccinations, as long as the travel doctor provides a proper prescription receipt that includes their name and the drug identification number (DIN). The total cost for the full series of all three vaccines would be $1180 Canadian – no small amount, so I was very appreciative of the prescription drug coverage I get through work. Unfortunately, my insurance doesn’t cover the cost of the actual appointment, so I always have to pay a little bit out of pocket for my travel vaccines.
#6 – Purchase Travel Medicine and Medical Supplies
After you visit the travel health clinic, you’ll need to make another stop at a pharmacy (or drug store, or supermarket…) to purchase any medications that were recommended by your doctor, along with a few travel heath essentials. Don’t leave this to the last minute, as occasionally pharmacies are sold out of a particular medicine and will have to place a special order or direct you to an alternate provider.
For my upcoming trip, I started by filling my regular prescription for an asthma inhaler (luckily my asthma isn’t bad, and it only tends to rear its head after I’ve been hiking for more than eight hours). Then, I picked up the medicines that had been recommended by the travel health pharmacist: limited quantities of malarone and doxycycline (only for use in the absolute most malaria-ridden places I planned to visit) along with some powerful antibiotics in case of severe food poisoning.
Fortunately, again, all of these medicines were covered by my employer’s prescription drug insurance plan, so I didn’t have to pay out-of-pocket. (Actually, I should clarify that I love paying out of pocket for everything, because I get lots of credit card points… then I submit the receipts to my insurer for reimbursement!)
In addition to the prescription medications, I also purchased a few travel essentials: a tiny emergency first aid kit (it was cute and it was on sale for $3.50, so I bought it!), individually-packed alcohol wipes, bandages and moleskine. I also like to bring emergency contraception (in case of rape, not as a primary method of birth control), antibiotic cream, hydrocortisone cream and painkillers, but I already had that stuff kicking around in my existing first aid kit. I always piece together my own first aid kit, but it’s also really easy to buy a pre-packed travel first aid kit on Amazon.
#7 – Record and Share Essential Travel Health and Insurance Information
Hopefully, once your trip begins you’ll be able to forget all about health and medical stuff completely. Ideally, you’ll never have to contact your travel insurance company, never have to visit a foreign clinic or foreign hospital, and never need to take any of those medications that you packed for your trip.
As they say, it’s best to hope for the best but plan for the worst. And the last step in sorting out your travel health program is making sure that you – and your emergency contacts – have access to all of your essential travel information in case of an accident, injury or illness overseas.
My strategy is to create digital copies of everything related to my travel health, and to keep a small (like, credit card-sized) paper copy of the absolute essentials in my travel wallet. Before I depart, I use a scanner to create full-color scans of documents related to my travel health. This includes everything from the letter from the government confirming my provincial health coverage was extended to official prescription receipts for the medicines my travel doctor prescribed. I upload these scans to my Google Drive and email a copy to my personal email address. The really essential stuff, like the certificate of coverage from my travel insurance company, also gets emailed to my emergency contacts.
In my wallet, I keep a tiny copy of my travel insurance policy and my emergency contact information. If your insurance company doesn’t issue wallet-sized cards, you can make your own by cropping the full-size certificate down to just the essentials, then using your computer’s “Print to PDF” function to scale it down to a small size before printing. Make sure the finished product clearly shows the name of the insurance company, all relevant policy numbers and the phone number for the claims department. I laminate this little card, and tape on another similar document with my emergency contact information.
There you go! Those are the seven steps I follow when I’m doing my travel health planning for a major trip abroad.
Did I miss anything? Am I overdoing things? Let me know your travel health secrets in the comments!