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When Finn Torjensen moved his family to China’s Shanxi province to start a medical training program, he thought he’d covered everything. Then the car he was riding in rolled off a cliff. After weeks in a Chinese hospital, doctors recommended that Torjensen be flown back to the U.S. for treatment. Out of necessity, his family went with him.

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"There was no way I could have gone back by myself. I had a broken neck," Torjensen said.

Worst-case scenarios happen. And when they happen overseas, things can get complicated.

Language barriers make communication difficult. Medicines are sometimes different. When hospitals within the country do not provide the required care, a medical evacuation may be necessary.

All of this means that if you live abroad, insurance companies consider you high maintenance. So if you need to buy health insurance overseas, it’s going to be difficult to get. If you have insurance, you may need to purchase additional coverage. And if you think you’re completely covered, read the fine print: some companies won’t cover you if you leave the country.

Luckily for Torjensen, he had done his research. But are you that well covered? And if not, what should you do?

Option 1: Continue your insurance from home. Your insurance needs will vary depending upon your destination and the length of time you plan to be outside of the U.S. Most people will simply continue the policy they already have; for U.S. citizens, a major medical plan offers the most comprehensive health insurance available. Many plans have a wide range of benefits and will continue to cover you as long as you pay your premiums. However, they probably won’t cover you forever.

Jackie Abrams, an insurance broker and director of American Citizens Abroad (ACA), a nonpartisan, nonprofit, Geneva-based organization that works to improve the status of American expatriates, has scoured the market to find insurance policies for her overseas clients.

"I don’t know of any U.S. policies that will cover you permanently out of the U.S.," Abrams said.

In fact, many companies will cancel their coverage if the policyholder lives outside of the country for more than 90 days. Even if you maintain an address in the States and continue to pay the premiums, some companies may dispute a claim or cancel a policy if they discover you have been living abroad.

If you have already moved overseas and discover that the policy you have does not actually cover you, your first reaction may be to find another insurance company. But that may be tricky. If you use an overseas address, many companies based in the U.S. will reject your application regardless of how healthy you are.

So before you sign up for an American insurance policy, ask very specific questions about the extent of the coverage. If you already have a policy, read the fine print. Finally, make sure your coverage starts before you leave the U.S.

The disadvantage of keeping a policy from back home is that it does not take an expat’s special needs into account. Most policies in the U.S. will not cover major medical evacuation, for example. And it may be difficult to put in a claim if all receipts are in a foreign language.

Luckily, there are emergency medical assistance companies to fill in the gap.

Option 2: Supplement your insurance. Emergency medical assistance companies do not offer comprehensive health insurance, but they can supplement an insurance policy by providing medical assistance in the event of an emergency.

Most offer 24-hour medical consultation via multi-lingual crisis phone lines, refer members to the nearest appropriate doctor or clinic, help fill prescriptions, monitor hospitalization, and, if needed, arrange an emergency medical evacuation to the nearest Western-standard hospital.

Two of the most widely-used medical assistance companies are AEA and SOS. AEA was founded in 1985 and is based in Singapore. SOS was founded in Switzerland in 1974 and is now headquartered in Philadelphia. Both have a worldwide network of doctors, hospitals, ambulances, administrative personnel, and inter- national-standard clinics.

Medical assistance and evacuation insurance is virtually useless, of course, if you don’t have a major medical policy to back it up. If you are already living abroad and need to buy insurance, there is one last option.

Option 3: Buy a special expatriate health insurance policy. A number of insurance companies offer such policies. The good news is that they will accept virtually any healthy person who applies, so if you’ve already moved overseas and are having trouble finding coverage, you aren’t completely out of luck.

Expat policies will usually offer worldwide coverage in addition to some type of evacuation insurance. When you apply for this type of insurance, you must specify a "usual country of residence" in addition to your country of citizenship. Most expat policies will discontinue coverage if you stay in your home country for more than 90 days.

If you are ever in need of a medical evacuation, expatriate policies will work in conjunction with an assistance company to send you to the nearest Western-standard hospital. This may or may not be in your home country. In other words, if you break your neck in Shanxi, the company would fly you to Hong Kong and pay your hospital bills. They probably won’t fly you back to the U.S., however.

There are other advantages to an expatriate plan. It is often cheaper than doubling up on several policies. It includes evacuation insurance. And it will cover shipping your mortal remains home if you happen to die.

But as a wise insurance guru once said, "Don’t look at the benefits. Look at the exclusions." Many so-called "international" policies are really temporary travel policies in disguise. If there is a maximum time frame, or if the plan requires that you reapply after one year, you are really buying a temporary policy.

The biggest problem with a temporary travel policy is that you may not be able to find another company to cover you when the plan expires. Many policies will allow you to reapply, but few guarantee that they will accept you. If you have put in a large claim, or if the condition of your health has deteriorated, you may be rejected. Even minor skin cancers will put a black mark on your record. A car accident may require a month in the hospital, but what if you need three years of physical therapy?

"If you get temporary insurance for six months and you get anything that will be considered pre-existing, you probably will not be able to obtain any insurance [after the plan expires]," Abrams said. "Depending on the illness, you could possibly never be insurable again."

This article can be viewed in its entirety in the May/June 1998 issue of Transitions Abroad magazine.