The closest thing to a health emergency on his mind was warding off sunburn, so he didn't opt for additional insurance coverage for his trip - let alone evacuation insurance.

Everything changed when, as he walked out of a restaurant, he felt faint, fell to the ground and hit his head.

Catania fractured his skull and suffered a brain bleed. He was taken to a local hospital on a Sunday, and on Monday morning, when doctors came to work, he was rushed into brain surgery.

After his wife, Erin, a cardiac nurse, learned about the accident, she connected with International SOS, a group that sells coverage for medical evacuations and other emergencies. Six hours after Erin arrived at the hospital in Mexico, the group flew in its air ambulance for Catania. The pricetag: $36,000 for the hospital stay and $36,000 for the evacuation.

"I didn't care if I had to mortgage the house," Erin said. "I knew I needed to get him home."

With a language barrier, uncertainty over his care and the knowledge that a long rehab was ahead, the Catanias had no choice. International SOS guaranteed the hospital bill would be paid - the only way Brad could have gotten discharged, since any health insurance payments would have to be sorted out at home later.

If you have a health emergency outside the United States, you could be left to pay for everything out of pocket - even if your insurance might provide some reimbursement. So before you dust off that passport, it's good to know what you're covered for (if at all) and how it would be paid for when you're overseas.

The U.S. State Department recommends travelers contact their health insurers to find out about coverage ahead of time. Don't expect to use your insurance card as you do at home. For those with coverage, it is likely to be a percentage reimbursement. Medicare, the government health insurance for the elderly, does not cover medical care outside the United States.

Miami-based attorney Jim Walker, who has dealt with families who have experienced all sorts of calamities while traveling, says there are very few destinations that would not warrant having evacuation insurance. Sweden, by contrast, would be a good place to become ill or injured because it has excellent, socialized medical care and care there wouldn't end up costing you.

That is not the typical scenario. And Walker cautions that choices can be severely limited and the potential costs high for someone with a serious illness who is forced off a cruise ship that is in transit.

"If you're in the Caribbean or Mexico and you don't have the insurance, you're just begging for something to go wrong," Walker said. "If you don't have a policy that gets an air ambulance to pick you up and get you back to the States you're in a lot of trouble. You've got to pay a few hundred dollars (for a policy) to get a $30,000 jet to get you out of there."

The State Department maintains lists on its website of companies that provide medical evacuations as well as insurance to cover such a potentially costly endeavor. Consumers should look toward companies such as International SOS - which also provides pre-trip guidance and has a list of medical providers the company recommends around the world - for that peace of mind, particularly if the travelers are children, elderly or have some mobility issues.

Coverage for a 35-year-old single person traveling to France for two weeks would cost about $140, rising by $20 for a 65-year-old. It would cost $230 to $350 for a family of five going to England for two weeks, depending on the level of coverage.

After Brad Catania successfully completed rehab, the family recently traveled back to Mexico -- this time with an International SOS membership that cost about $300 and would cover an evacuation. Money well spent, Erin said.

HOW TO PREPARE

Here's a checklist from the State Department of questions to ask about evacuation policies before making a purchase:

* Does the insurance policy cover emergency expenses abroad such as returning me to the United States for treatment if I become seriously ill?

* Does the insurance cover high-risk activities such as para-sailing, mountain climbing, scuba diving and off-roading?

* Does the policy cover pre-existing conditions?

* Does the insurance company require pre-authorizations or second opinions before emergency treatment can begin?

* Does the insurance company guarantee medical payments abroad?

* Will the insurance company pay foreign hospitals and foreign doctors directly?

* Does the insurance company have a 24-hour physician-backed support center?

(Editing by Lauren Young, Beth Pinsker Gladstone and Leslie Adler)

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