Medical Insurance -- For travel overseas, most U.S. 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.
As a safety net, you may want to buy travel medical insurance, particularly if you're traveling to a remote or high-risk area where emergency evacuation might be necessary. If you require additional medical insurance, try MEDEX Assistance (tel. 800/537-2029 or 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; www.worldwideassistance.com).
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.
Travelers from the U.K. should carry their European Health Insurance Card (EHIC), which replaced the E111 form as proof of entitlement to free/reduced cost medical treatment abroad (tel. 0845/605-0707; www.ehic.org.uk). Note, however, that the EHIC covers only "necessary medical treatment."
Travel Insurance -- The cost of travel insurance varies widely, depending on the destination, 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. You can get estimates from various providers through InsureMyTrip.com (tel. 800/487-4722). Enter your trip cost and dates, your age, and other information, for prices from more than a dozen companies.
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 (tel. 0845/345-5708), which compares prices across a wide range of providers for single- and multi-trip 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.com).
Trip-Cancellation Insurance -- Trip-cancellation insurance will help retrieve your money if you have to back out of a trip or depart early, or if your travel supplier goes bankrupt. Trip cancellation traditionally covers such events as sickness, natural disasters, and State Department advisories. 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. 800/228-9792; www.travelex-insurance.com).
Spain should not pose any major health hazards. The rich cuisine -- garlic, olive oil, and wine -- may give some travelers mild diarrhea, so take along antidiarrhea medicine, moderate your eating habits, and even though the water is generally safe, drink bottled or mineral water. (Do not drink the water in mountain streams, regardless of how clear and pure it looks.) Fish and shellfish from the horrendously polluted Mediterranean should only be eaten if cooked.
If you are traveling around Spain (particularly southern Spain) over the summer, limit your exposure to the sun, especially during the first few days of your trip and, thereafter, from 11am to 2pm. Use a sunscreen with a high sun protection factor (SPF) and apply it liberally. Remember that children need more protection than adults do.
General Availability of Health Care -- Spanish medical facilities are among the best in the world. If a medical emergency arises, your hotel staff can usually put you in touch with a reliable doctor. If not, contact the American embassy or a consulate; each one maintains a list of English-speaking doctors. Medical and hospital services aren't free, so be sure that you have appropriate insurance coverage before you travel.
Contact the International Association for Medical Assistance to Travelers (IAMAT; tel. 716/754-4883, or 416/652-0137 in Canada; 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/CDC-INFO or 404/498-1515; 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).
In Canada, contact Health Canada (tel. 613/957-2991; www.hc-sc.gc.ca).
What to Do If You Get Sick Away from Home -- 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.medjetassist.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 a day, 7 days a week. Annual memberships are $250 individual, $385 family; you can also purchase short-term memberships.
U.K. nationals will need a European Health Insurance Card (EHIC; tel. 0845/605-0707; www.ehic.org.uk) to receive free or reduced-cost health benefits during a visit to a European Economic Area (EEA) country (E.U. 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 see www.dh.gov.uk/travellers.
If you suffer from a chronic illness, consult your doctor before your departure. Pack prescription medications in your carry-on luggage, and carry them in their original containers, with pharmacy labels -- otherwise they won't make it through airport security. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.
Spain became a victim of terror on March 11, 2004, when terrorists attacked its rail system in Madrid, slaughtering innocent lives. The terrorists left 13 backpacks and gym bags in commuter trains as they pulled into three of the city's most crowded stations. Each held some 25 pounds of high explosives, with detonators wired to cellphones. As they rang, 10 of the bombs went off, causing massive carnage and the loss of 190 lives, with an additional 1,500 injured. No terrorist operation that big had ever hit Western Europe.
What can you do to protect yourself from terrorist attacks? Regrettably, very little. Spanish tourism officials at first feared massive cancellations of visitors' trips to Spain. That didn't happen. Could it be that the traveling public is learning to live under the threat of terror, knowing that you might be no safer in your home city than you would be in London, Paris, or Madrid?
The Basque separatist group, ETA, remains active in Spain. Although ETA efforts have historically been directed against police, military, and other Spanish government targets, in March 2001, ETA issued a communiqué announcing its intention to target Spanish tourist areas to harm the country's economy. Americans have not been the specific targets of ETA activities. The Spanish government is vigorously engaged in combating terrorism at home and abroad and has been able to avert many terrorist activities. Over the years, ETA has conducted many successful attacks, many of which have resulted in deaths and injuries.
In December 2006, ETA admitted to carrying out a bomb attack at the Madrid airport that killed two people. ETA claimed that the attack was not intended to harm anyone, and the group condemned the government for not evacuating the targeted building. The terrorist group had given advance warning.
U.S. tourists traveling to Spain should exercise caution and refer to the Worldwide Caution public announcements issued in the wake of the September 11, 2001, terrorist attacks in the U.S. and the March 11, 2004, train attacks in Madrid. These announcements are updated by the U.S. Department of State and are available at http://travel.state.gov.
While most of Spain has a moderate rate of crime, and the vast majority of tourists have trouble-free visits to Spain each year, the principal tourist areas have been experiencing an increase in violent crime. Madrid and Barcelona, in particular, have reported growing incidents of muggings and violent attacks, and older tourists and Asian Americans seem to be particularly at risk. Criminals frequent tourist areas and major attractions such as museums, monuments, restaurants, hotels, beach resorts, trains, train stations, airports, subways, and ATMs. In Barcelona, violent attacks have occurred near the Picasso Museum and in the Gothic Quarter, Parc Guell, Plaza Real, and Montjuïc. In Madrid, reported incidents occur in key tourist areas, including the area near the Museo del Prado and Atocha train station, and areas of Old Madrid like Sol, El Rastro flea market, and Plaza Mayor. Travelers should exercise caution; carry limited cash and credit cards; and leave extra cash, credit cards, passports, and personal documents in a safe location. Crimes have occurred at all times of day and night.
Thieves often work in teams or pairs. In most cases, one person distracts a victim while an accomplice robs you. For example, a stranger might wave a map in your face and ask for directions or "inadvertently" spill something on you. While your attention is diverted, the accomplice makes off with the valuables. Attacks can also be initiated from behind, with the victim being grabbed around the neck and choked by one assailant while others rifle through the belongings. A group of assailants may surround the victim, maybe in a crowded popular tourist area or on public transportation, and only after the group has departed does the person discover he or she has been robbed. Some attacks have been so violent that victims have needed medical attention after the attack.
Theft from parked cars is also common. Small items like luggage, cameras, or briefcases are often stolen from parked cars. Travelers are advised not to leave valuables in parked cars and to keep doors locked, windows rolled up, and valuables out of sight when driving. Unfortunately, "Good Samaritan" scams are also common. A passing car will attempt to divert the driver's attention by indicating there is a mechanical problem. If the driver stops to check the vehicle, accomplices steal from the car while the driver is looking elsewhere. Drivers should be cautious about accepting help from anyone other than a uniformed Spanish police officer or Civil Guard.
The loss or theft abroad of a passport should be reported immediately to the local police and your nearest embassy or consulate. U.S. citizens may refer to the Department of State's pamphlet, A Safe Trip Abroad, for ways to promote a more trouble-free journey. The pamphlet is available by mail from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402; or via the Internet at http://travel.state.gov/travel/tips/safety/safety_1747.html.