I was teaching English in Hanoi when the abdominal pain started. A CT scan at the French Hospital revealed a tumor. I called my “long-term travel insurance” provider, expecting them to authorize chemotherapy. Instead, the case manager said, “We are booking you a flight to Seattle on Tuesday. Your coverage ends the moment you land.”
Key Takeaways
- Travel Insurance Stabilizes, Global Health Treats: Standard nomad insurance (SafetyWing, World Nomads) is for emergencies. Once you are stable enough to fly, they will evacuate you to your home country and terminate the policy. They do not pay for chemo or radiation abroad.
- The “Fit to Fly” Rule: If a doctor says you can sit in an economy seat, the insurer’s obligation is to fly you home. They will not pay for expensive local treatment just because you prefer to stay.
- Global Medical Insurance: Plans like Cigna Global or GeoBlue are the only ones that will pay for long-term cancer treatment (oncology) in a foreign country.
- The Pre-Existing Trap: If you had any symptoms before buying the policy (even undiagnosed pain), they will deny the entire claim as pre-existing.
The “Why” (The Trap)
The trap is “Emergency Evacuation vs. Medical Management.”
Nomad insurance is designed to protect the insurer from catastrophic costs. A flight home costs them $2,000. Cancer treatment in Vietnam costs $50,000+. Therefore, the policy language gives them the right to repatriate you the moment a condition becomes “chronic” or requires long-term care. If you refuse the flight, your coverage voids immediately.
The Investigation: I Called Them
- SafetyWing (Nomad Insurance): I asked, “If I get cancer, will you pay for chemo in Bangkok?” The answer was a hard no. “We cover the initial hospitalization and diagnostics. Once diagnosed, we transport you to your home country for treatment.”
- Cigna Global (Gold Plan): I spoke to an advisor. “We cover oncology fully. If you want to be treated in Singapore or Bangkok, we pay the hospital directly. We do not force you home.”
- Genki (Resident): This plan sits in the middle. They cover medically necessary treatment abroad, but they reserve the right to repatriate if the treatment is significantly cheaper at home or if the local facilities are inadequate.
Comparison Table: Cancer Coverage
| Feature | Travel/Nomad Insurance | Global Health (Cigna/Bupa) | Local Expat Insurance (e.g. Luma) |
| Chemotherapy Abroad | NO (Evacuation only) | YES | YES |
| Medical Evacuation | YES (Mandatory) | YES (Optional) | Varies |
| Home Country Care | NO (Policy ends) | YES (If US included) | NO |
| Cost | ~$45/mo | ~$300/mo | ~$150/mo |
[IMAGE: A hospital discharge paper stamped ‘Fit to Fly’ next to a plane ticket, contrasting with a chemotherapy schedule]
Step-by-Step Action Plan
- Check Your “Home Country”: If your passport is American, but you haven’t lived there in 10 years and have no insurance there, being evacuated is a financial death sentence. You need a Global Health plan that treats you abroad.
- Upgrade if Over 40: The risk of critical illness rises with age. Move from cheap travel insurance to Cigna/GeoBlue/April International.
- Keep an Emergency Fund: If you are evacuated, you might need $5k cash to get set up back home (apartment/deposit) while you apply for Medicaid or Marketplace insurance.
- Read “Repatriation” Clauses: Look for the phrase “If medically appropriate, we reserve the right to return you…” That means they decide where you get treated, not you.
FAQ
Will they fly me on a private jet?
Only if medically necessary (e.g., you are on a ventilator). If you can walk, you are flying commercial, possibly in a stretcher row.
Can I choose where I’m evacuated to?
No. Travel insurance flies you to your country of citizenship or residence. You can’t say “Send me to Germany because the hospitals are better” if you are American.
What if I can’t fly?
Then they must treat you locally until you can fly.