Successful travel, whether for business or pleasure, usually requires a lot of planning. Amid all the details and perhaps dreams, who wants to worry about getting seriously ill or having a bad accident while faraway from home?

While you can't prevent a medical crisis, you can ease the burden by adding one more step in trip planning: purchasing adequate travel insurance, including insurance that covers evacuation caused by serious medical needs.

The options are a "per trip" policy that covers the insured for a specific journey at a certain time, and an annual insurance policy covering all travel during that time. Either way, getting medical evacuation insurance could be the most important travel decision you make.

Despite decades of travel to numerous less developed countries, I had never realized the importance of getting insurance that covered emergency evacuation until some years ago when my neighbor came to my door, tears streaming down her cheeks. "In the middle of the night we got a phone call from the U.S. Embassy in Nepal," she said. "Namat (their college-age son) was hit by a bus while riding his motorbike. The embassy wanted our credit card number and permission to airlift him to a hospital in Kathmandu."

A doctor in Kathmandu successfully set his hip and operated on one of his wrists, and five days later he was flown home on a commercial jet for further surgery.

The following week, while traveling alone in China, I began thinking about my neighbor's accident in Nepal. I decided to have a look at a few hospitals in Shanghai.

In a privately operated hospital, the patients appeared to be receiving excellent medical care. But at another facility, considered one of the city's best public hospitals, I followed the signs to the "Foreigners' and Diplomats' Floor." The physical conditions and equipment were antiquated and in disrepair. Two women visiting a friend initiated a conversation with me in the hallway.

"Ordinarily, when someone in the diplomatic service needs emergency hospitalization or surgery, a medical evacuation flight is arranged either to Hong Kong or Bangkok, where there are superior facilities, but there wasn't enough time to do this for our friend."

Later, in southwest China, the manager of my hotel told me that if a guest were injured, "We would send the guest in an ambulance to the nearest hospital." Now on a quest, I took a taxi to that hospital and wandered through several filthy halls crowded with people waiting for attention. It was a nightmare!

I learned later that the cost of a medical evacuation from China to a hospital in the United States would have been about $50,000 and it would not have been covered by my medical insurance.

Recently, the doctor aboard my ship in the South China Sea, said it could easily cost close to $100,000 to arrange an air evacuation at sea. Sometimes, passengers do not give the ship's doctor information about their medical evacuation coverage.

Additional personal experiences (including independent travel in Peru, Ecuador, India, Cambodia, Vietnam, and Nepal) have taught me much more about this issue. I have developed a list of questions each traveler should have answered before embarking on a journey:

1. Does an existing policy cover injury, hospitalization and emergency evacuation abroad? Medicare does not.
2. Will a travel insurance policy reimburse expenses in a medical emergency or will it provide cash up front as required by many doctors and hospitals in other nations?
3. Are there pre-existing health conditions that would prevent my qualifying for medical travel coverage?
4. Can the insured call an emergency assistance coordination center around the clock if help is suddenly needed?
5. Who does what when the insured makes the notification call to the insurer?
6. Is the insurer responsible for arranging the next step in medical care, or would the insured person now a patient-- be responsible for getting a referral to satisfactory care?
7. Who decides if a medical evacuation is necessary? The insured, the insured's doctor at home, a doctor abroad, an employee of the medical insurance company?
8. Will evacuation be provided only to the nearest appropriate facility or to a hospital of the patient's choice?
9. What are the coverage limits and exclusions?
10. What happens if the policy holder dies while traveling abroad?

The following situations illustrate the necessity of having answers to these questions before you travel:

When I broke a rib and injured my knee while hiking in Switzerland last summer, the doctor required $265 in cash (he would NOT take a credit card) before providing services.

This is true in many countries. My HMO reimbursed me less the deductible which another pre-trip policy paid.

Even when you purchase an individual trip policy that covers medical evacuation, "the criteria of what constitutes 'adequate care' (at the nearest hospital) is not always consistent among travel insurance providers," said Dan McGinnity, vice president of AIG Travel Guard, one of the world's leading providers of travel insurance and assistance.

"Global companies like AIG Travel Guard have full time medical professionals who consult with the attending physicians in a serious medical emergency, and determine whether or not the facility has the capability to provide the necessary treatment. Not all companies have this capability."

For example, the doctor on a cruise ship in Mexico recommended that the husband of my friend be taken immediately to the nearest hospital, where a team of doctors operated and saved his life.

When his attending doctor felt he should stay in the hospital another week before traveling home on a commercial flight, my friend contacted the U.S. consulate, which helped her arrange for a second opinion. That doctor conferred with the couple's travel insurance company. The next morning, a medically-equipped Learjet arrived to fly the couple back to their hometown and have the man transferred to the hospital there.

Until recently, Travel Guard's individual "per trip" policies covered medical evacuation only to the nearest adequate medical facility. McGinnity explained the new, broader policy.

"Our annual medical evacuation plan is geared to the needs of frequent travelers. It includes evacuation home or to the hospital of the client's choice when the attending physician, in consultation with our global medical staff, deems an evacuation is required."

Unlike most medical evacuation plans, Travel Guard's annual and per trip MedEvac plans also includes $25,000 of medical expense coverage and unlimited med evac expenses as well as 24/7 access to travel assistance services that are available any time you travel.

Roy Berger, president of MedJet Assist, outlined his company's annual emergency evacuation policy: "If your condition is critical and you can gain inpatient status at the hospital at both ends, we will bring you home from abroad in a dedicated air ambulance to the hospital of your choice."

Members of the American Automobile Association who choose to purchase the additional "Plus" plan are eligible for up to $25,000 of emergency medical transportation coverage and 24-hour medical emergency assistance.

According to Emily Porter, the insurer's marketing director for AAA, that coverage includes "reasonable and necessary services needed for the transportation of your remains from the place of death to the place of residence."

Many basic travel insurance policies exclude reimbursement for payment of care for treatment of existing, significant medical conditions that create problems during travel unless the travel insurance policy is purchased within 15 days of the initial trip purchase that covers the full cost of all non-refundable trip expenses.

In addition to emergency evacuation, individual trip policies usually include trip interruption and cancellation; lost, stolen or damaged baggage; travel or baggage delay; dental and medical expenses. Rates are typically dependent on the cost of the trip, the length of the trip, your age, and the type of insurance you choose. Details vary widely, so ask for explanations of any unclear language.

MORE INFORMATION

For a comparative analysis of travel insurance companies and plans, go to www.insuremytrip.com. Major insurers include:
o Travel Guard International, www.TravelGuard.com; 800-826-1300
o Medjet Assist, www.medjetassist.com; 800-963-3538
o AAA, www.aaa.com; 800-203-7587
o International SOS , the largest worldwide emergency evacuation service, tailors memberships to the needs of business travelers, students with study programs abroad, group travelers and expatriates; www.intsos.com; 800-523-8661

As noted, U.S. embassies and consulates can provide limited aid. To provide pre-recorded help for these officials during an emergency, travelers should include emergency contact information on the page provided in the passport.

In addition, when you are traveling alone, always be sure to carry the following information on your person:
-your name, address, telephone number
-blood type, religion
-contact information for your: primary care physician,
med evac policy, funeral home, administrator of your will, person designated to make health care decisions, and your financial planner