A serious medical emergency abroad brings together three linked risks: your health, the practical logistics, and the cost. If local facilities can’t provide the level of care you need, you may require a medically supervised transfer — sometimes by air ambulance, sometimes via a managed commercial flight with a medical escort. These services are high-cost and, in most cases, are arranged through the insurer’s 24/7 assistance team rather than “on demand”. This guide explains what “medical evacuation” and “repatriation” typically mean within international private medical insurance (IPMI), how assistance works in practice, what is commonly covered or excluded, and what to do step by step in a real emergency.
Prepare for a worst-case scenario before you travel:
- Save your insurer’s 24/7 assistance number on your phone and keep it with your travel documents (and a copy stored digitally).
- Record local emergency numbers (ambulance, police and fire) for all countries on your itinerary.
- Carry your policy documents, membership card and a list of current medications and allergies.
- Put a trusted person “in the loop” and, where appropriate, give them authority to liaise with the insurer if you are unable to.
- Ensure you have access to funds or a credit card for upfront costs; some hospitals may request a deposit before treatment or admission.
- Evacuation vs repatriation: Evacuation is a transfer to the nearest appropriate facility when local care is inadequate; repatriation is a planned return “home” once you are stable. Return of remains is usually a separate benefit.[1]
- Not a personal preference benefit: Evacuation is typically arranged (or declined) based on medical necessity, safety and feasibility — not simply because you would rather be treated elsewhere.[1]
- Cover varies by policy: Some plans include evacuation, repatriation and return of remains as standard; others treat one or more as optional benefits and may apply sub-limits or territorial restrictions.
- Medical necessity & approvals: Insurers generally pay for services they consider medically necessary and often require prior approval for onward transfers.[2] In an emergency, notify them as soon as it is safe to do so.
- Immediate actions: If it’s life-threatening, call local emergency services first.[4] Once stabilised, contact the insurer’s assistance team and keep medical notes, bills and receipts.[4]
- Assistance is operational, not just a phone line: Assistance providers can coordinate clinical oversight, provider liaison, guarantees of payment (where appropriate), and transport logistics — but they operate within policy terms and local constraints.[7]
- Plan before you need it: Store the right contacts and documents, understand your area of cover, and know who should call on your behalf. A broker can help you understand wording and process, but cannot guarantee authorisation.
Definition of evacuation vs repatriation
Getting the terminology clear helps you manage expectations and make better decisions under pressure. Medical evacuation (often shortened to “medevac”) is emergency transport from a location where suitable treatment is not available to a nearby facility that can provide appropriate care. The CDC notes that these transfers are usually arranged by insurers and assistance providers, rather than at the traveller’s discretion.[1]
Medical repatriation typically refers to a planned return to your home country (or your usual country of residence) once you are stable and it is clinically appropriate to travel — often for continued treatment, rehabilitation or ongoing care.[7] Repatriation of remains is the transport of a deceased person’s body or ashes to the final resting place, subject to legal and practical requirements.[5] These are distinct benefits with different triggers and different rules.
It also helps to understand common policy terms such as assistance provider (a specialist company that coordinates support and transport), medical necessity (treatment and services needed to diagnose or treat a condition and not primarily for convenience),[2] nearest appropriate facility (the closest hospital capable of providing the required level of care), stabilisation (making you safe to travel), pre-authorisation (insurer approval in advance), and a guarantee of payment (a document the insurer/assistance provider may issue to support direct settlement with a hospital, subject to terms and information received).[4]
| Term | Description |
|---|---|
| Medical evacuation (medevac) | Emergency transport from a location lacking adequate treatment to the nearest facility capable of providing appropriate care; typically coordinated via the insurer’s/assistance provider’s process and clinical oversight.[1] |
| Medical repatriation | A planned transfer “home” (often to your country of residence) once you are stable and travel is clinically appropriate, to continue care or recover closer to home.[7] |
| Repatriation of remains | Transporting human remains to the final resting place, subject to documentation and regulatory requirements.[5] |
| Assistance provider | Specialist 24/7 service contracted by insurers to coordinate medical support, provider liaison, transport logistics and (where appropriate) guarantees of payment.[7] |
| Medical necessity | Services intended to evaluate, diagnose or treat illness or injury, aligned to accepted medical standards and not primarily for convenience. Exact definitions vary by insurer/policy.[2] |
| Nearest appropriate facility | The closest hospital able to provide the level of care required. Evacuation usually aims for this, rather than a facility of personal choice. |
| Stabilisation | Immediate care to control or improve a serious condition so you can be safely moved, if movement is required. |
| Pre-authorisation | Insurer approval required before certain services are arranged; used to confirm eligibility and agree the process for direct settlement or reimbursement. |
| Guarantee of payment (GOP) | A document the insurer/assistance provider may issue to support direct settlement with a hospital for eligible costs, subject to policy terms and the information received.[4] |
| Air ambulance vs commercial stretcher | An air ambulance is a dedicated medical aircraft (often with intensive care capability). A commercial stretcher is a stretcher space on a scheduled passenger flight with clinical support. The option used depends on medical condition, distance and operational feasibility. |
| Escort/medical attendant | A nurse or doctor who accompanies you during evacuation or repatriation to provide care and support safe travel. |
The practical implication is important: evacuation is primarily about getting you to appropriate care quickly, whereas repatriation is usually considered later, once you are stable and the move makes clinical and operational sense.
When evacuation is used
Evacuations are relatively rare, but they can be life-saving. The CDC describes medical evacuation as something arranged when the quality of care at your location is inadequate and a transfer is required to access appropriate treatment.[1] In practice, most insurers and assistance providers will look for the following before approving a transfer:
- You need care that isn’t available locally. Typically this is confirmed by the treating clinician and assessed by the insurer’s medical team.
- The transfer is medically necessary. Policies generally only respond to treatment and services considered medically necessary (and not primarily for convenience).[2]
- It can be done safely and legally. Assistance teams will consider stability to fly, availability of aircraft and crew, airspace/airport access, and whether a receiving hospital can accept you.
Situations where evacuation may be considered
Evacuation may be considered in scenarios such as:
- Major trauma or critical illness where specialist care is required and not accessible locally.
- Complex treatment (for example, surgery or intensive care) that is not available at the treating facility.
- Limited diagnostic capability where essential imaging or specialist assessment is not available locally.
- Wider disruption (such as a natural disaster) where local services cannot safely provide the required care.
When evacuation may be declined
Common reasons include:
- It’s not clinically required. If appropriate care is available locally, the insurer may expect you to remain where you are.
- It’s primarily for preference. Wanting treatment in a particular city or country does not, by itself, meet “medical necessity”.
- Territorial/exclusion issues. Restrictions relating to area of cover, sanctions, conflict zones, or excluded activities may prevent the benefit responding.
- Unauthorised arrangements. If you arrange onward transport without involving the assistance team, reimbursement may be limited or declined, depending on the policy wording.
The practical takeaway: if there is any doubt and it is safe to do so, contact the insurer’s 24/7 assistance team before arranging an onward transfer yourself. They can confirm the process and what approvals or documentation they need — without that implying the transfer will be authorised.
What typical IPMI policies cover
Cover varies by insurer and plan design, but many comprehensive IPMI policies include a suite of evacuation and repatriation-related benefits supported by a 24/7 assistance service. The table below summarises common components and where issues can arise. Always cross-check the policy schedule, definitions and exclusions for the definitive position.
| What it is | When it applies | Typical requirements | Common limitations | Documents you may need | What can go wrong |
|---|---|---|---|---|---|
| Emergency medical evacuation | Serious illness or injury where local facilities cannot provide adequate treatment; you need transfer to the nearest appropriate facility.[1] | Clinical assessment and confirmation of medical necessity; stabilisation where possible; insurer/assistance approval where feasible; transport and landing permissions. | Usually limited to the nearest suitable facility (not necessarily your preferred destination); may exclude certain territories/activities; may be subject to sub-limits or policy limits; may not include “homeward” travel at this stage. | Policy details; ID/passport; medical reports/diagnosis; treating clinician contact details; consent to share medical information. | Weather/airspace disruption; delays securing permits or a receiving bed; incomplete records slowing clinical sign-off; you are not stable enough to fly; territorial restrictions apply. |
| Medical repatriation | Once you are stable and travel is clinically appropriate, you return to your home country/normal country of residence for continued care or recovery.[7] | Fit-to-fly confirmation; insurer/assistance approval; coordination with a receiving hospital/clinician; travel logistics (often commercial with medical escort, depending on need). | Not always included as standard; destination may be restricted (for example, within area of cover); may involve cost sharing (excess/deductible, co-insurance); companion benefits vary; timing can depend on bed availability and travel routes. | As above, plus fit-to-fly/medical clearance and (where required) confirmation of acceptance by receiving provider. | Flight scheduling delays; immigration/entry issues; receiving provider cannot accept; insurer considers local care adequate; condition changes during travel requiring re-planning. |
| Return of mortal remains | In the event of death abroad, arranging preparation and transport of remains (or ashes) to an agreed destination, subject to legal requirements.[5] | Death certificate; compliance with transport rules and permits; consular input where relevant; insurer notification and case management. | Often subject to a separate benefit limit; may not cover ceremonial or family travel costs; exclusions may apply depending on cause of death and policy terms. | Death certificate (and translations where required); permits; passport details; next-of-kin authorisation; funeral director documentation. | Delays due to investigations; documentation mismatches; airline/route constraints; costs exceeding policy limits; differing requirements between jurisdictions. |
| Companion/escort travel | A relative/friend travels to be with you during an eligible hospital stay or accompanies you during repatriation; may include return of dependent children in some cases.[7] | Minimum hospitalisation period may apply; insurer approval; relationship and travel documentation. | Often limited to one companion; usually economy travel; accommodation may be limited or excluded; eligibility criteria vary. | Passports; proof of relationship; receipts; hospital confirmation. | Visa issues; flight availability; disagreements about who qualifies; insufficient documentation to evidence eligibility. |
| Assistance services | 24/7 support for triage, referrals, clinical coordination, and (where appropriate) arranging direct settlement/guarantees of payment.[7] | Policy details and consent to share medical information; cooperation with medical monitoring and documentation requests. | Support is not a substitute for local emergency care; service scope varies by policy; operational constraints can affect timing; privacy requirements may slow information sharing. | Policy number; contact details; symptoms summary; hospital/clinician details. | Language barriers; missing information; delays reaching the right hospital department; unclear authority to consent when the patient is incapacitated. |
| Replacement of medication / medical essentials | In some arrangements, assistance teams help source replacement medication/devices (subject to local law and availability).[7] | Valid prescription and clinician confirmation; legal import/shipping requirements. | Often limited; controlled drugs may be restricted; shipping delays and customs barriers are common. | Prescription; clinician statement; pharmacy details. | Customs refusal; medication unavailable locally; documentation not accepted; timing issues in urgent situations. |
The key point is that these benefits are procedural as well as financial: the insurer’s/assistance team typically needs to be involved so that clinical sign-off, logistics and settlement arrangements can happen in the correct order.
Limitations and exclusions
IPMI can provide valuable support, but it is not open-ended. Evacuation and repatriation benefits are typically subject to eligibility criteria, policy limits and exclusions. Common points to watch include:
- Non-medically necessary transport. Wanting to return home for convenience or preference is not usually enough; insurers generally require medical necessity.[2]
- Unauthorised arrangements. If you arrange your own onward transport without involving the insurer/assistance team, reimbursement may be limited or declined, depending on the policy wording and circumstances.[7]
- Pre-existing conditions. Cover for evacuation linked to pre-existing conditions depends on disclosure, underwriting decisions, waiting periods and endorsements/exclusions.
- High-risk activities or destinations. Some activities and territories may be excluded unless you have specific additional cover. Always check both policy exclusions and travel/territory restrictions.
- Mental health emergencies. Some policies restrict evacuation for psychiatric crises unless there is an immediate and serious risk and the criteria are met.
- Pregnancy and newborn care. Many policies place limits later in pregnancy or apply specific rules around complications and neonatal care — check the maternity benefit wording carefully.
- Alcohol, drugs and illegal acts. Claims arising from intoxication or unlawful activity are commonly excluded, although wording varies.
Cost sharing and limits
Even where a transfer is covered, you may still have out-of-pocket costs. Depending on the plan, this can include an excess/deductible, co-insurance or co-payments, and shortfalls where charges exceed “reasonable and customary” benchmarks or any sub-limits. Some policies treat evacuation within the overall annual limit; others have a separate benefit limit. Always check the schedule.
Geographic limitations
Most IPMI policies define an area of cover (for example, worldwide, or worldwide excluding the USA). Evacuation and repatriation benefits typically operate within that area and may be limited or excluded elsewhere. Some policies also exclude sanctioned territories or areas of active conflict, and practical access may be restricted even where cover might otherwise apply.
Operational realities
Even with approval, transfers can be delayed by aircraft and crew availability, weather, airspace restrictions, visas/entry permissions, and availability of a suitable receiving bed. These factors sit outside the insurer’s control and can affect timing and route.
Practical steps during an emergency
Step-by-step guidance
Emergencies are stressful. A simple plan can reduce delays and avoid avoidable coverage issues. This is not medical advice — it’s practical “process” guidance aligned with common insurer procedures and government travel advice.
- Get urgent help first. If it’s life-threatening, call local emergency services and get to the nearest emergency facility.[4]
- Allow stabilisation. Accept immediate local treatment to stabilise you. Onward transfers (especially by air) usually require you to be fit to travel.
- Contact the insurer’s 24/7 assistance team as soon as safe. Once immediate danger is addressed, contact the insurer/assistance line and open a case.[4] If you cannot call, ask a travelling companion or the hospital to call on your behalf.
- Share the essentials. Give your policy number, location, hospital details, a brief summary of what has happened, and the treating clinician’s contact details.
- Collect and keep paperwork. Ask for admission notes, discharge summaries, itemised invoices, and receipts for any payments made. Keep copies of test results where possible.[4]
- Inform a trusted contact. Tell a family member or trusted person where you are and share the insurer’s assistance contact and your case reference.
- Don’t self-arrange onward transport if you can avoid it. If there’s any doubt and it is safe to do so, let the assistance team confirm the process and approvals needed before you arrange transfers yourself.
Flowchart: The evacuation process
Life-threatening emergency → Call local emergency number → Stabilisation at nearest facility → Contact insurer’s assistance team → Assistance liaises with treating clinician → Is local care adequate?
• Yes → Continue treatment locally; repatriation may be considered later if clinically appropriate.
• No → Assistance arranges medical evacuation to the nearest appropriate facility → Travel via air ambulance/ground transport (as clinically required) → Admission at receiving hospital → Ongoing care → Assessment for repatriation once stable.
Planned/managed transfer (serious but not immediately life-threatening) → Contact insurer’s assistance team before arranging transport → Provide medical reports and treating clinician’s view → Assistance evaluates medical necessity and feasibility → Is evacuation warranted?
• Yes → Pre-authorisation (where required) and transport arranged.
• No → Continue care locally and monitor; the policy may still respond to eligible treatment costs, subject to terms.
Checklist: emergency contacts and documents to store
- Insurer’s 24/7 assistance details – saved on your phone and stored with your documents (membership card/policy schedule is usually the source).
- Policy essentials – policy number, member ID, and a copy of the benefits schedule (digital + hard copy if practical).
- Local emergency numbers – ambulance/police/fire for each destination.
- ID and travel documents – passport and visa copies, stored separately from originals.
- Medical essentials – medications (name + dose), allergies, chronic conditions, and key clinician details; add translations if needed.
- Authority/consent – a named person who can speak to the insurer/hospital if you cannot, and any relevant consent arrangements.
- Access to funds – a card or contingency funds for deposits or incidental costs; some facilities may request upfront payment.[3]
- Key contacts – family contact, employer (if relevant), embassy/consulate details, and your broker.
“What to say” mini-script
“Hello. I’m calling from [city, country]. My name is [your name] and my policy number is [number].
I’m at [hospital name] and have been admitted with [brief description]. The treating clinician is [name] and can be reached on [phone].
Please open a case and tell me what you need from the hospital. Can you also advise whether a guarantee of payment or any prior approval is required?
My contact number is [phone] and email is [email]. Thank you.”
“I have international private medical insurance. My insurer’s assistance team can advise on direct settlement and, where appropriate, issue a guarantee of payment.
Please contact them on [assistance number] and quote my details: [name, date of birth, policy number if needed].
Could you also provide itemised invoices and copies of the medical reports for anything billed to me?”
“I’m in [city, country] and I’ve had a [accident/illness]. I’m at [hospital name].
I’ve contacted my insurer’s assistance team and they’ve opened a case. The case reference is [number].
Please keep this information confidential, but be ready to help coordinate if I’m transferred. My policy documents are stored in [location].”
Common pitfalls and how to avoid them
- Self-arranging onward transport. If it’s safe to do so, involve the assistance team before you make transfer arrangements yourself.
- Assuming “travel assistance” equals “medical evacuation cover”. Some services provide advice and referrals but do not necessarily pay evacuation costs. Check your benefits schedule.
- Being outside your area of cover. Confirm territorial limits and whether short trips outside the area are covered automatically or require an extension/endorsement.
- Requesting a move that isn’t medically necessary. A preference for treatment “back home” may be understandable, but it may not meet the policy’s criteria.
- Underestimating cost sharing and sub-limits. Know how your excess/deductible and any co-insurance applies, and whether there are specific benefit caps.
- Documentation gaps. Missing clinical notes or itemised invoices commonly slows claims and can complicate direct settlement.
- Sanctions/war-zone restrictions. Policies often contain exclusions and insurers may be unable to operate in restricted territories. Verify wording if you travel to higher-risk regions.
- Communication delays. Save numbers, identify a trusted caller, and keep a written summary of your details to reduce misunderstandings.
Coordination with assistance providers
What assistance providers do
Assistance providers are the operational backbone behind evacuation and repatriation benefits. They typically run 24/7 centres staffed by clinical and logistics specialists and can support with:
- Pre-trip advice on health risks and practical travel considerations (where included).[7]
- Clinical coordination and monitoring by liaising with treating clinicians and reviewing records to assess suitability for transfer.[7]
- Direct settlement support by liaising with providers and, where appropriate, issuing guarantees of payment in line with policy terms.[4]
- Referrals and language support (for example, identifying suitable hospitals and arranging interpreting where available).[7]
- Transport logistics for evacuation/repatriation including aircraft, ground transfers, escorts and receiving facility coordination.[7]
- Family support such as companion travel or dependent child arrangements where the policy includes it.[7]
Why they matter
In practical terms, a good assistance process reduces delays and avoids costly mistakes — particularly around provider communication, clinical sign-off and documentation. However, assistance teams are not a substitute for local emergency services, and they cannot approve something the policy does not cover. Clear communication, prompt consent, and providing accurate information usually makes the process smoother.
Data and privacy considerations
To assess your case, the insurer/assistance provider will often need medical information such as diagnosis, test results and clinician notes. Data protection requirements may apply (for example, GDPR/UK GDPR where relevant), and you may be asked to provide written consent so information can be shared between the hospital, the assistance team and the insurer. If you are unsure, ask what information is needed, who it will be shared with, and how it will be stored.
Questions to ask insurers
When choosing or renewing an IPMI policy, these questions help you sense-check whether evacuation and repatriation benefits match your likely risks:
- Is emergency medical evacuation included as standard, or only as an optional benefit? If included, is it capped or subject to specific terms?
- Is medical repatriation included, and what counts as “home”? Some policies treat repatriation differently from evacuation — confirm the destination rules.
- Is return of remains included? If so, what costs are included (preparation, transport, documentation) and what is excluded (for example, ceremonial costs)?[5]
- How does the policy define “medical necessity” and “nearest appropriate facility”? Ask for the wording used in the definitions section.[2]
- What is the process for approvals and guarantees of payment? Who should initiate the call (you, the hospital, someone at home)? What are the notification timescales for emergency admissions?[4]
- Who chooses the provider and method of transport? Clarify whether the insurer/assistance provider appoints the air ambulance/escort and how decisions are made.
- What territorial restrictions apply? Confirm the area of cover, excluded territories, and how travel warnings/sanctions wording is applied.
- How do excess/deductibles and co-insurance apply to emergency transport? Some plans apply cost sharing; others may waive it for certain emergencies.
- Do exclusions apply to hazardous pursuits or specific sports? If you do higher-risk activities, confirm whether additional cover is required.
- What evidence is required if you need to claim by reimbursement? Ask about documentation, translations and submission deadlines.
Comparing on process and exclusions — not just premium — tends to give you a more realistic view of how the policy may perform when you actually need it.
Role of brokers in arranging evacuation
How brokers support you
A specialist broker helps you understand policy wording and compare options, particularly where benefits are defined differently between insurers. In the context of evacuation/repatriation, brokers can help by:
- Explaining how benefits are framed (definitions, exclusions, sub-limits, territorial restrictions and cost sharing).
- Helping you prepare so you have the right documents and know the correct assistance contact route before you travel.
- Supporting communication by helping you understand what the insurer is asking for and what information the hospital may need to provide.
- Assisting with claims and follow-ups once the immediate situation is under control, particularly where paperwork is missing or timelines are unclear.
What brokers cannot do
Brokers cannot authorise an evacuation or repatriation and cannot guarantee a payment decision. Those decisions sit with the insurer and/or their assistance provider, based on the policy terms, clinical information and local conditions.
Get started
Evacuation and repatriation benefits can make a meaningful difference in a serious incident — but only if you understand how the process works and what your policy actually says. If you’re reviewing cover for yourself or your family:
- Review your current policy for evacuation, repatriation and return of remains, including any sub-limits and territorial rules.
- Check your process (who calls, what you need to provide, and how quickly you should notify the insurer in an emergency).
- Prepare your emergency kit so your contacts and documents are accessible under pressure.
For more information, visit our Individuals & Families page. Our FAQ covers common questions about international health plans and assistance support. If you’re planning a move abroad, read IPMI Abroad: The Guide to Getting Health Cover Right Before You Move. To compare insurers and what matters in practice, see Choosing the Right Insurer for International Health Insurance.
Points to verify
Before you need to rely on these benefits, check the following in your policy documents and the insurer’s published guidance:
- Definitions: “medical necessity”, “nearest appropriate facility” and “repatriation” can be defined differently and drive eligibility.
- What’s included as standard vs optional: evacuation only, evacuation + repatriation, and return of remains may sit in different sections or require add-ons.
- Benefit limits and sub-limits: whether evacuation/repatriation has its own cap or sits within an overall annual limit.
- Cost sharing: whether an excess/deductible or co-insurance applies to emergency transport (and whether it’s waived in any scenarios).
- Area of cover and territorial exclusions: confirm excluded territories and how sanctions/travel restrictions are treated.
- Approvals and notification: who must contact the assistance team, by when, and what happens if you are incapacitated.
- Provider choice: who appoints the air ambulance/escort and how the transport method is selected.
- Companion benefits: who qualifies, what costs are covered (travel/accommodation), and what evidence is required.
- Documentation and timelines: what to collect, whether translations are required, and submission deadlines for reimbursement claims.
The goal is to remove uncertainty now, so you’re not trying to interpret policy language in the middle of a crisis.
