Health & Insurance

Check your existing insurance policies before you buy travel insurance to cover trip cancellation, lost luggage, medical expenses, or car-rental insurance. You're likely to already have partial or complete coverage. But if you need some, ask your travel agent about a comprehensive package. The cost of travel insurance varies widely, depending on the cost and length of your trip, your age and overall health, and the type of trip you're taking. Insurance for extreme sports or adventure travel, for example, will cost more than coverage for a cruise.

Some credit cards (American Express and certain gold and platinum Visas and MasterCards, for example) offer automatic flight insurance against death or dismemberment in case of an airplane crash if you charged the cost of your ticket.

For information on travel insurance, contact one of the following popular insurers:

Access America (tel. 866/807-3982; www.accessamerica.com)

Travel Guard International (tel. 800/826-4919; www.travelguard.com)

Travel Insured International (tel. 800/243-3174; www.travelinsured.com)

Travelex Insurance Services (tel. 888/457-4602; www.travelex-insurance.com)

Trip Cancellation Insurance

There are three major types of trip-cancellation insurance-one that covers you in the event that you prepay a cruise or tour that gets cancelled, and you can't get your money back; a second that covers when you or someone in your family gets sick or dies, and you can't travel (but beware that you may not be covered for a preexisting condition); and a third that covers you when bad weather such as a hurricane makes travel impossible. Some insurers provide coverage for events like jury duty, natural disasters close to home, such as floods or fire, and even the loss of a job. A few have added provisions for cancellations because of terrorist activities. Always check the fine print before signing on, and don't buy trip-cancellation insurance from the tour operator that may be responsible for the cancellation; buy it only from a reputable travel insurance agency. Don't overbuy, because you won't be reimbursed for more than the cost of your trip.

Medical Insurance

Most health insurance policies cover you if you get sick away from home, but they are not likely to provide for medical evacuation in case of life-threatening injury or illness. It's a good idea to buy a travel insurance policy that provides for emergency medical evacuation. If you have to buy a one-way same-day ticket home and forfeit your nonrefundable round-trip ticket, you might be out big bucks. And the cost of a flying ambulance could wipe out your life's savings.

Check with your insurer, particularly if you're insured by an HMO, about the extent of its coverage while you're overseas. With the exception of certain HMOs and Medicare/Medicaid, your medical insurance should cover medical treatment-even hospital care-overseas. However, most out-of-country hospitals make you pay your bills up front, and they send you a refund after you've returned home and filed the necessary paperwork.

If you require additional insurance, try one of the following companies:

MEDEX International (tel. 888/MEDEX-00 or 410/453-6300; fax 410/453-6301; www.medexassist.com)

Travel Assistance International (tel. 800/821-2828; www.travelassistance.com); for general information on services, call the company's Worldwide Assistance Services, Inc. at tel. 800/777-8710.

The Divers Alert Network (DAN) (tel. 800/446-2671 or 919/684-2948; www.diversalertnetwork.org)

Lost-Luggage Insurance

On U.S. domestic flights, including those to Puerto Rico, checked baggage is covered up to $2,500 per ticketed passenger. If you plan to check items more valuable than the standard liability, you can purchase "excess valuation" coverage from the airline, up to $5,000. Be sure to take any valuables or irreplaceable items with you in your carry-on luggage. If you file a lost luggage claim, be prepared to answer detailed questions about the contents of your baggage, and be sure to file a claim immediately, as most airlines enforce a 21-day deadline. Before you leave home, compile an inventory of all packed items and a rough estimate of the total value to ensure that you're properly compensated if your luggage is lost. You will only be reimbursed for what you lost, no more. Once you've filed a complaint, persist in securing your reimbursement; there are no laws governing the length of time a carrier can take to reimburse you. If you arrive at a destination without your bags, ask the airline to forward them to your hotel or to your next destination; they will usually comply. If your bag is delayed or lost, the airline might reimburse you for reasonable expenses, such as a toothbrush or a set of clothes, but the airline is under no legal obligation to do so.

Lost luggage may also be covered by your homeowner's or renter's policy. Many platinum and gold credit cards cover you for lost luggage as well, provided your air ticket was purchased using one of the platinum or gold credit cards. If you choose to purchase additional lost-luggage insurance, be sure not to buy more than you need. Buy in advance from an insurer or a trusted agent (prices will be much higher at the airport).

Car-Rental Insurance (Loss/Damage Waiver or Collision Damage Waiver)

If you hold a private auto insurance policy in the United States, you are probably covered in Puerto Rico for loss or damage to the car, and liability in case a passenger is injured. The credit card you used to rent the car might also provide some coverage.

Car-rental insurance probably does not cover liability if you caused the accident. Check your own auto insurance policy, the rental company policy, and your credit card coverage for the extent of coverage: Is your destination covered? Are other drivers covered? How much liability is covered if a passenger is injured? (If you rely on your credit card for coverage, you might want to bring a second credit card with you, as damages may be charged to your card and you might find yourself stranded with no money or remaining credit.)

Car-rental insurance in Puerto Rico costs about $15 to $40 a day.

Staying Healthy

Puerto Rico poses no major health problem for most travelers. If you have a chronic condition, however, you should check with your doctor before visiting the islands. For conditions such as epilepsy, diabetes, or heart problems, wear a MedicAlert Identification Tag (tel. 800/825-3785; www.medicalert.org), which will immediately alert doctors to your condition and give them access to your records through MedicAlert's 24-hour hot line.

Finding a good doctor in Puerto Rico is easy, and most speak English.

If you worry about getting sick away from home, consider purchasing medical travel insurance and carry your ID card in your purse or wallet. In most cases, your existing health plan will provide the coverage you need. See "Travel Insurance," above, for more information.

Pack prescription medications in your carry-on luggage, and carry prescription medications in their original containers. Also bring along copies of your prescriptions in case you lose your medication or run out. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

And don't forget sunglasses and an extra pair of contact lenses or prescription glasses.

Contact the International Association for Medical Assistance to Travellers (IAMAT; tel. 716/754-4883, or in Canada 416/652-0137; www.iamat.org) for tips on travel and health concerns in Puerto Rico and lists of local, English-speaking doctors. If you get sick, consider asking your hotel concierge to recommend a local doctor-even his or her own. You can also try the emergency room at a local hospital; many have walk-in clinics for emergency cases that are not life threatening. You might not get immediate attention, but you won't pay the high price of an emergency-room visit (usually a minimum of $300 just for signing your name). The United States Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on necessary vaccines and health hazards by region or country.

It's best to stick to bottled mineral water here. Although tap water is said to be safe to drink, many visitors experience diarrhea, even if they follow the usual precautions. The illness usually passes quickly without medication if you eat simply prepared food and drink only mineral water until you recover. If symptoms persist, consult a doctor.

The sun can be brutal, especially if you haven't been exposed to it in some time. Experts advise that you limit your time on the beach the first day. If you do overexpose yourself, stay out of the sun until you recover. If your exposure is followed by fever or chills, a headache, or a feeling of nausea or dizziness, see a doctor.

Sandflies (or "no-see-ums") are one of the biggest insect menaces in Puerto Rico. They appear mainly in the early evening, and even if you can't see these tiny bugs, you sure can "feel-um," as any native Puerto Rican will attest. Screens can't keep them out, so you'll need to use your favorite insect repellent.

Although mosquitoes are a nuisance, they do not carry malaria in Puerto Rico. However, after a long absence, the dreaded dengue fever has returned to Puerto Rico. The disease is transmitted by the Aede mosquito, and its symptoms include fever, headaches, pain in the muscles and joints, skin blisters, and hemorrhaging. Most of its victims lack any defense against it.

Hookworm and other intestinal parasites are relatively common in the Caribbean, though you are less likely to be affected in Puerto Rico than on other islands. Hookworm can be contracted by just walking barefoot on an infected beach. Schistosomiasis (also called bilharzia), caused by a parasitic fluke, can be contracted by submerging your feet in rivers and lakes infested with a certain species of snail.

Puerto Rico has been especially hard hit by AIDS. Exercise at least the same caution in choosing your sexual partners, and in practicing safe sex, as you would at home.

Staying Safe

The U.S. State Department issues no special travel advisories for the Commonwealth of Puerto Rico, the way it might for, say, the more troubled island of Jamaica. However, there are problems in Puerto Rico, especially muggings along San Juan's Condado and Isla Verde beaches. Auto theft and cars getting broken into are other major problems. Do not leave valuables in cars, even when the doors are locked.

Take precautions about leaving valuables on the beach, and exercise extreme care if you're searching for a remote beach where there's no one in sight. The only person lurking nearby might be someone not interested in surf and sand but a robber waiting to make off with your possessions.

Avoid wandering around the darkened and relatively deserted alleys and small streets of San Juan's Old Town at night, especially a section called El Callejón, near the intersection of calles San Sebastián and Tanca. Be especially careful along the narrow alley that connects this intersection with Calle Norzagaray. The district attracts more drug dealers than any other spot in Puerto Rico. A number of muggings also occur in Old Town's Cementerio de San Juan.