Health & Insurance

Travel Insurance

Check your existing insurance policies and credit card coverage before you buy travel insurance. You may already be covered for lost luggage, canceled tickets, or medical expenses. The cost of travel insurance varies widely, depending on the cost and length of your trip, your age and health, and the type of trip you're taking, but expect to pay between 5% and 8% of the vacation itself.

U.K. citizens and their families who make more than one trip abroad per year may find an annual travel insurance policy works out cheaper. Check www.moneysupermarket.com, which compares prices across a wide range of providers for single- and multitrip policies.

Most big travel agents offer their own insurance and will probably try to sell you their package when you book a holiday. Think before you sign. Britain's Consumers' Association recommends that you insist on seeing the policy and reading the fine print before buying travel insurance. The Association of British Insurers (tel. 020/7600-3333; www.abi.org.uk) gives advice by phone and publishes Holiday Insurance, a free guide to policy provisions and prices. You might also shop around for better deals: Try Columbus Direct (tel. 0870/033-9988; www.columbusdirect.net).

Trip-Cancellation Insurance -- Trip-cancellation insurance helps you get your money back if you have to back out of a trip, if you have to go home early, or if your travel supplier goes bankrupt. Allowed reasons for cancellation can range from sickness to natural disasters to the State Department declaring your destination unsafe for travel. (Insurers usually won't cover vague fears, though, as many travelers discovered who tried to cancel their trips in Oct 2001 because they were wary of flying.) In this unstable world, trip-cancellation insurance is a good buy if you're getting tickets well in advance -- who knows what the state of the world, or of your airline, will be in 9 months? Insurance policy details vary, so read the fine print -- and make sure that your airline or cruise line is on the list of carriers covered in case of bankruptcy. A good resource is "Travel Guard Alerts," a list of companies considered high-risk by Travel Guard International. Protect yourself further by paying for the insurance with a credit card -- by law, you can get your money back on goods and services not received if you report the loss within 60 days after the charge is listed on your credit card statement.

Note: Many tour operators, particularly those offering trips to remote or high-risk areas, include insurance in the cost of the trip or can arrange insurance policies through a partnering provider, a convenient and often cost-effective way for the traveler to obtain insurance. Make sure the tour company is a reputable one, however: Some experts suggest you avoid buying insurance from the tour or cruise company you're traveling with, saying it's better to buy from a "third party" insurer than to put all your money in one place.

The latest news in trip-cancellation insurance is the availability of expanded hurricane coverage and the "any-reason" cancellation coverage -- which costs more but covers cancellations made for any reason. You won't get back 100% of your prepaid trip cost, but you'll be refunded a substantial portion. TravelSafe (tel. 888/885-7233; www.travelsafe.com) offers both types of coverage. Expedia also offers any-reason cancellation coverage for its air-hotel packages.

For details, contact one of the following recommended 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); and Travelex Insurance Services (tel. 888/457-4602; www.travelex-insurance.com).

Medical Insurance -- For travel overseas, most health plans (including Medicare and Medicaid) do not provide coverage, and the ones that do often require you to pay for services upfront and reimburse you only after you return home. Even if your plan does cover overseas treatment, most Russian and other out-of-country hospitals make you pay your bills upfront, and send you a refund only after you've returned home and filed the necessary paperwork with your insurance company. As a safety net, you may want to buy travel medical insurance, particularly if you're traveling beyond Moscow and St. Petersburg to a remote or high-risk area of Russia where emergency evacuation is a possible scenario. If you require additional medical insurance, try MEDEX Assistance (tel. 410/453-6300; www.medexassist.com) or 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).

Canadians should check with their provincial health plan offices or call Health Canada (tel. 866/225-0709; www.hc-sc.gc.ca) to find out the extent of their coverage and what documentation and receipts they must take home in case they are treated overseas.

Lost-Luggage Insurance -- On international flights (including U.S. portions of international trips), baggage coverage is limited to approximately $9.07 per pound, up to approximately $635 per checked bag. If you plan to check items more valuable than what's covered by the standard liability, see if your homeowner's policy covers your valuables, get baggage insurance as part of your comprehensive travel-insurance package, or buy Travel Guard's "BagTrak" product.

If your luggage is lost, immediately file a lost-luggage claim at the airport, detailing the luggage contents. Most airlines require that you report delayed, damaged, or lost baggage within 4 hours of arrival. The airlines are required to deliver luggage, once found, directly to your house or destination free of charge.

Staying Healthy

No vaccinations are necessary to visit Russia, though there have been cases of diphtheria and cholera in provincial areas in recent years, and tuberculosis is a major problem in prisons. Most visitors' biggest health challenges are digestive, either from St. Petersburg's bacteria-ridden water or dubiously prepared street food. Bottled water is cheap and widely available. HIV is a growing problem, and prevention and public information campaigns are sorely inadequate.

General Availability of Healthcare

Soviet healthcare was universal and nearly free, though clinics were chronically short of equipment. State subsidies shriveled in the 1990s and shortages worsened; doctors remain dismally paid and depend heavily on bribes from patients. But competition is slowly emerging, and Moscow and St. Petersburg have several private clinics that offer high-standard care and English-speaking personnel, though at high prices.

Bring any prescriptions with you, and Imodium or other anti-diarrhea medication. All-night pharmacies are common in Moscow and St. Petersburg, and over-the-counter medications are easily available, though generics are rarer. Foreign brands are often of better quality and always more expensive than their Russian equivalents. For the bold, even penicillin and IUDs can be purchased without a prescription.

Contact the International Association for Medical Assistance to Travelers (IAMAT; (tel. 716/754-4883 or, in Canada, 416/652-0137; www.iamat.org) for tips on travel and health concerns in the countries you're visiting, and for lists of local, English-speaking doctors. The United States Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. Travel Health Online (www.tripprep.com), sponsored by a consortium of travel medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable medical clinics overseas at the International Society of Travel Medicine (www.istm.org).

Common Ailments

Dietary Red Flags -- Moscow's water is potable but can be risky for foreigners. St. Petersburg's water contains the bacteria giardia lamblia and should be avoided (beware of tooth-brushing and iced drinks). Many St. Petersburg hotels have their own water filtration system. Cheap bottled water is widely available. Avoid fried meat pies sold on the street and meat sold outdoors. Vegetarians are finding more and more options in Russia, mainly at restaurants that specialize in Japanese or American cuisine. However, nearly all restaurant soups are made with meat stock, and vegetable side dishes are often prepared in lard. Although Russia has substantial Muslim and Jewish minorities, very few restaurants cater to those with religious dietary restrictions.

Respiratory Illnesses -- Tuberculosis, virtually wiped out by Soviet health campaigns, has resurfaced in recent years, largely among prison populations. The disease is treatable but some strains have grown resistant to standard medicines. Another respiratory challenge is air quality, which is dismal in most Russian cities. Fuel emissions are restricted but the restrictions are barely enforced.

Extreme Weather Exposure -- Though Russia is no doubt a cold place, most travelers do not spend enough time outdoors in the winter to risk hypothermia or its milder cousin, frostbite. Visitors engaging in a lot of outdoor winter activity should carry many layers of clothing and thermoses of warm liquid.

Healthy Travels to You

The following government websites offer up-to-date health-related travel advice.

Australia: www.dfat.gov.au/travel/

Canada: www.hc-sc.gc.ca/index_e.html

U.K.: www.dh.gov.uk/en/Policyandguidance/Healthadvicefortravellers

U.S.: www.cdc.gov/travel/

What to Do If You Get Sick Away From Home

Any foreign consulate can provide you with a list of area doctors who speak English. 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. Finding doctors or all-night pharmacies can be hard in Moscow and St. Petersburg if you know no Russian, and is much easier with a Russian helper or hotel concierge. You will pay as you go no matter where you seek help, and prices can vary from a few dollars in a public clinic for emergency care to hundreds of dollars in a private one. Foreigners are sometimes charged more just because they are assumed to have more money than Russians.

For travel abroad, you may have to pay all medical costs upfront and be reimbursed later. Medicare and Medicaid do not provide coverage for medical costs outside the U.S. Before leaving home, find out what medical services your health insurance covers. To protect yourself, consider buying medical travel insurance.

Very few health insurance plans pay for medical evacuation back to the U.S. (which can cost $10,000 and up). A number of companies offer medical evacuation services anywhere in the world. If you're ever hospitalized more than 150 miles from home, MedjetAssist (tel. 800/527-7478; www.medjetassistance.com) will pick you up and fly you to the hospital of your choice virtually anywhere in the world in a medically equipped and staffed aircraft 24 hours day, 7 days a week. Annual memberships are $225 individual, $350 family; you can also purchase short-term memberships.

U.K. nationals will need a European Health Insurance Card (EHIC) to receive free or reduced-costs health benefits during a visit to a European Economic Area (EEA) country (European Union countries plus Iceland, Liechtenstein, and Norway) or Switzerland. The European Health Insurance Card replaces the E111 form, which is no longer valid. For advice, ask at your local post office or visit www.dh.gov.uk/travellers.

If you suffer from a chronic illness, consult your doctor before your departure. For conditions like epilepsy, diabetes, or heart problems, wear a MedicAlert identification tag (tel. 888/633-4298; 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.

Pack prescription medications in your carry-on luggage, and carry prescription medications in their original containers, with pharmacy labels -- otherwise they won't make it through airport security. Also bring along copies of your prescriptions in case you lose your pills or run out. Don't forget an extra pair of contact lenses or prescription glasses. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.