Health Insurance Requirements Abroad: What Does It Cover?

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I was lying in a hostel in Chiang Mai with a 102°F (39°C) fever when it hit me: I had no idea whether my insurance even applied here. The doctor wanted 4,500 baht up front (about $130), and I sat there with my Austrian e-card, which was worth exactly zero in Thailand. I could have spared myself that situation if I had known beforehand which health insurance requirements abroad really apply and what they cover.

The truth is: many of us go abroad with completely wrong assumptions. Some think their home health insurer pays everywhere, others take out an expensive supplemental policy they don't need at all. I'll show you what coverage you really need and where you can save money without putting your health at risk.

What does the Austrian health insurer really pay for abroad?

Within the EU and the EEA (plus Switzerland), the European Health Insurance Card applies, which is printed on the back of your e-card. It sounds practical but has massive limitations. The Austrian Health Insurance Fund (ÖGK) only covers services that are customary in the country you're staying in, and only at the rates there.

A concrete example: when my friend Lisa needed a dentist in Barcelona, the e-card covered the treatment at the public health center CAP Drassanes. But the repatriation home to Vienna, which would have cost €15,000 (about $16,500), would have been completely out of pocket. According to the ÖGK, repatriation is generally not covered, no matter how medically necessary it is.

Outside the EU, the e-card doesn't work at all. In countries like Australia, New Zealand, Thailand or the USA, you have to pay for every medical service yourself first. The ÖGK then reimburses at most the amount the treatment would have cost in Austria. For an appendectomy in New York, which can quickly cost $25,000, you might get back €3,000 (about $3,300). The rest is on you.

Is international health insurance required by law?

The short answer: for Austrian citizens, there is no general health insurance requirement abroad. The longer answer: it depends on your destination country, the length of your stay and your status.

Many countries require health insurance as a condition of the visa. For the Working Holiday visa in Australia, you have to prove you're insured for the entire length of your stay. New Zealand requires minimum coverage of NZD 200,000 (about $120,000) for medical and hospital care. Canada also requires proof, especially since the rules were tightened in 2024.

There are exceptions within the EU too: Germany requires au pairs and students to show proof of adequate health insurance. According to the German Federal Ministry of Health, it must at least match the benefit level of statutory health insurance. In concrete terms, that means a pure travel health policy is often not enough.

Even where there's no legal requirement, it can get expensive. An acquaintance of mine had to spend three days in intensive care in the USA after a motorcycle accident. The bill: $87,000. Without insurance, it would have ruined him financially. If you want to know more about financial planning for longer stays abroad, check out my guide to earning money for your gap year abroad.

Which medical services are really covered abroad?

That depends enormously on your policy. Over the years, I've tested five different international health insurance policies, and the differences are huge. The basic rule: read the fine print before you sign.

By default, any reasonable international health insurance should cover the following:

• Outpatient and inpatient treatment for acute illnesses and accidents
• Necessary medication and dressings
• Dental treatment for pain (usually capped at €500-1,000, about $550-1,100)
• Medical repatriation to Austria if medically sensible or necessary
• Repatriation in the event of death (sounds morbid, but it's important)

What many insurers do NOT cover: pre-existing conditions, chronic illnesses, pregnancy and birth, treatment resulting from drug use or high-risk sports. When I wanted to learn to surf in Bali, I had to add an adventure sports clause for an extra €35 ($40). Without it, a surfing accident wouldn't have been insured.

A critical point is how costs are covered: some insurers settle directly with the hospital (assistance service), while others work on a reimbursement basis. On my first trip to Southeast Asia, I had a cheap policy that only reimbursed. That meant I had to front €2,800 (about $3,050) for food poisoning in Bangkok and wait three months for the reimbursement. With my current insurance (Allianz Worldwide Care), I call the hotline and they sort everything out directly with the clinic.

Which health insurance do I really need abroad?

That depends on your specific plan. For a two-week beach vacation in Greece, the e-card plus an inexpensive travel health policy for €8-15 ($9-16) is theoretically enough. For longer stays, it gets more complex.

If you're traveling for 6-12 months, whether it's Work and Travel, digital nomad life or studying abroad, you need long-term international health insurance. Since 2019, I've mainly been insured with HanseMerkur, which has good rates especially for digital nomads. Cost: about €35 ($38) a month for worldwide coverage (except USA/Canada, where it would be €95, or $105).

Important: the insurance must apply from day one. I made the mistake of taking out my first policy only a week after departure. When I needed a doctor that week, I was stuck. Since then, I always book the insurance at the same time as the flight.

Special rules apply in special situations: au pairs often need insurance that also covers minor preventive checkups. Au pair insurance is an important topic here. Work and Travellers should make sure that even short jobs (under three months) are covered, since many countries otherwise require separate work insurance.

The hidden costs: What insurers like to keep quiet

This is where it gets really annoying. Many insurers have deductibles that aren't mentioned prominently in advertising. With my first policy at ERV, I had a deductible of €100 ($110) per claim. Sounds okay, but it wasn't: every doctor's visit counted as its own claim. Three visits to the doctor for the same flu? Three times a €100 deductible.

Then there are waiting periods. Some insurers don't cover dental treatment in the first three months or have a four-week waiting period for certain conditions. If you're unlucky and have to see the dentist in exactly that window, you pay yourself.

According to a 2023 study by the Vienna Chamber of Labour (Arbeiterkammer Wien), 62 percent of travelers have never fully read their insurance terms. That leads to nasty surprises. A classic: the insurer only covers the cost of the cheapest treatment alternative. If you go to a private hospital even though a public hospital was available, you're stuck with the difference.

My personal recommendations after 5 years of full-time travel

After countless insurance claims (from stomach bugs in India to a sprained ankle in Portugal), these are my takeaways:

First: never travel for longer than a month without worldwide coverage. The few extra euros are worth it. I currently pay €42 ($46) a month at HanseMerkur for a policy that is valid worldwide (including USA/Canada), has no deductible and settles directly with clinics.

Second: make sure the insurance has a 24/7 emergency service in your language. When I was sitting in a clinic in Manila at three in the morning, the German-language hotline was worth its weight in gold. They not only phoned the hospital but also explained which documents I needed for the later claim.

Third: document EVERYTHING. I got into the habit of taking a photo of every doctor's visit, every bill and every prescription and uploading it straight to the cloud. In a complicated case in Vietnam, I had all the paperwork ready that way, which massively sped up the reimbursement.

Fourth: check whether your credit card includes travel health insurance. Some premium cards like the American Express Platinum have built-in international health insurance for trips up to 90 days. That can save you a separate policy, but read the terms carefully. Often the coverage limits are too low or important services are excluded.

If you're still at the very beginning of your planning, also check out my packing list for Work and Travel, where I also cover important documents and insurance papers that belong in your luggage.

Health insurance requirements for longer stays abroad: The legal situation

If you stay abroad for more than six months, the legal side gets interesting. In Austria, you're generally required to have insurance as long as your primary residence is here. If you deregister, your Austrian health insurance also ends, and you have to get insured in your host country or take out an international policy.

Many digital nomads operate in a gray area: they're officially registered in Austria but actually live abroad. That can work but carries risks. First, the e-card doesn't work outside the EU anyway, and second, the ÖGK can theoretically refuse benefits if you've demonstrably not been in Austria for a longer period.

A clean solution is international health insurance that is valid worldwide and not tied to a place of residence. Providers like Cigna Global or Allianz Worldwide offer such policies from about €150 ($165) a month. Expensive, but you're on the safe side and can switch between countries without having to adjust the insurance each time.

According to EU Regulation 883/2004 on the coordination of social security systems: anyone who works in an EU member state must also be health-insured there. That applies, for example, to au pairs or Work and Travellers with longer jobs in Germany or France. In that case, you may have to register in the host country and pay social security contributions there.

Health protection during a stay abroad: Practical tips for emergencies

The best insurance is useless if you don't know how to activate it in an emergency. I always save my insurer's emergency number as a favorite in my phone, with the country code in case I call from abroad. For HanseMerkur it's +49 40 55557877, the people there speak German and are reachable around the clock.

Second tip: always carry a copy of your insurance policy, ideally both digital and printed. In many countries, the hospital wants to see proof before they treat you. I keep my insurance number, the emergency number and a short English explanation of my coverage on an index card in my wallet.

Third tip: find out about the local health system beforehand. In Thailand you pay in cash and submit the bill later, in Spain you go to the public health center with the e-card, and in the USA you need a direct billing service or you're stuck with horrendous bills. The Austrian Foreign Ministry's website has info on the health system for every country. It's dryly written but helps enormously.

Fourth tip: put together a small travel first-aid kit. It sounds banal but saves money and nerves. I always carry painkillers, anti-diarrhea medicine, bandages and disinfectant. That lets me treat 80 percent of minor ailments myself without needing to see a doctor. In many countries (especially Southeast Asia), you can get medication without a prescription, but the quality isn't always guaranteed.

Frequently asked questions about health insurance requirements abroad

Is my Austrian e-card also valid outside the EU?

No, the e-card with the European Health Insurance Card only applies within the EU, the EEA and Switzerland. Outside these countries, you have to pay for medical services privately and can later apply to the ÖGK for reimbursement, but only up to the level of Austrian rates, which is usually significantly less than the actual costs.

How much does good international health insurance cost for a year?

For worldwide long-term international health insurance, you pay between €400 and €1,200 a year (about $435-1,300), depending on the scope of coverage and destination region. Policies without USA/Canada are cheaper (from €35, or $38, a month at HanseMerkur), with North America coverage more like €80-100 ($87-109) a month. Premium policies with a deductible option or extended benefits can cost up to €2,500 ($2,700) a year.

Do I have to get health insurance abroad if I stay longer than 6 months?

That depends on the host country. Within the EU, you're covered by the e-card as long as you're registered in Austria. For longer stays outside the EU, or if you work in the host country, there may be an insurance requirement in that country. Australia, New Zealand and Canada, for example, require proof of insurance for Working Holiday visas. International health insurance is in any case the safest solution for longer stays abroad.

Does the insurance also pay for dangerous sports like surfing or motorcycling?

Most standard international health policies exclude high-risk sports or cover them only for an extra charge. Motorcycling is often only insured up to 125 cc, and for larger machines you need an additional clause. Surfing, diving, climbing and off-piste skiing count as dangerous activities, so check your policy or book an adventure sports extension for €20-50 ($22-55) extra a year. In Bali I had a case where the insurer rejected a surfing accident because I hadn't booked the clause.

What happens if I get pregnant abroad?

Most international health policies cover neither planned pregnancies nor births. Emergency treatment for complications is often insured, but regular prenatal care and birth are not. If you plan to become pregnant or are already pregnant, you need a special policy. Some insurers like BDAE offer pregnancy clauses, but they cost significantly more. Within the EU, the e-card also applies to pregnancy and birth at the rates of the host country.

Conclusion: What coverage you really need

After five years of constant travel and half a dozen insurance claims, my takeaway is clear: don't save in the wrong place. Good international health insurance may cost you around €500 ($545) a year, while a serious illness without insurance can ruin you financially. I've heard enough horror stories from people who came back from the USA with €50,000 ($54,500) in debt.

My recommendation: for short trips within the EU, the e-card plus an inexpensive supplementary policy for repatriation is enough. For anything over a month or outside Europe: invest in a proper long-term policy with worldwide coverage, direct billing and 24/7 support. Watch for hidden exclusions, document everything and read the fine print before you sign.

Health insurance requirements abroad aren't equally strict everywhere, but the risk of being left without protection is too high. I'm glad that after my fever attack in Chiang Mai, I quickly learned which insurance I really need. Today I travel with a clear conscience because I know: if something happens, I'm covered. That's worth every euro.