Barbara Rogers President & CEO National Emphysema/COPD Association

1. Barbara Rogers President & CEO National Emphysema/COPD Association

2. Disclosure None

3. Travel Issues: International Concerns, Insurance Preparations, and Disability Act Issues Travel & the Respiratory Patient

4. Here’s How Respiratory Patients Can Plan for a Safe Trip… • Pick a safe, healthy destination • Consult with their doctor • Buy health insurance • Prepare and pack medications and medical equipment • Arrange for oxygen supply and equipment needs • Prepare for climate and air quality at their destination • Pace themselves- eat well, sleep well and don’t drink too much

5. Pick a Safe and Healthy Destination • Make sure the vacation destination will be in a safe place, close to medical services • Avoid areas where there is inadequate or questionable medical help • Avoid places that can't provide smoke-free accommodations • Avoid places filled with their respiratory triggers • Avoid places with extreme temperatures (very cold, or very hot and humid)

6. Communication! Patient’s Should Consult Their Doctor Before They Leave… The doctor should know: • When they will leave • Where they will go • How long they will be traveling • Will they be traveling alone • How they’ve been feeling over the past few months

7. What the patient should know prior to leaving… • Their health is stable and all necessary medications and immunizations have been provided, as well as any special needs (oxygen, face masks, ventilators, etc.) can be met • Some individuals who are not oxygen-dependent on the ground may require oxygen during air travel • If supplemental oxygen is needed, verify that supplies of oxygen are available in those specific areas

8. Patients Should Have With Them • A brief written medical history with back-up copies for their records at home • An updated medication schedule and written prescriptions for all medications, including a prescription for oxygen, if needed • Patients travelling overseas, can contact the IAMAT (the International Association of Medical Assistance to Travelers). This non-profit world-wide association has English-speaking doctors ready to help international travelers

9. Basic Medical Information for Americans Abroad • If an American citizen becomes seriously ill or injured abroad, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends

10. Buying Health Insurance- Do I Need Medical/ Evacuation Coverage? Yes! Here’s a simple rule of thumb: “If you are traveling outside your home country, you need emergency medical coverage”

11. Travel Medical Insurance BasicsMedical Coverage for Americans Abroad • Most health insurance plans in the U.S. only cover patients while in the U.S., so when they leave the country they have no medical or accident coverage • This is also true for Medicare, which does not cover patients outside the U.S.

12. Medigap Plans in General • There are 12 standard Medicare supplemental (Medigap) insurance plans that help pay some of the costs in the original Medicare Plan and for some health care costs it doesn't cover • All Medigap plans must cover certain basic benefits • Each standard plan, labeled "A" through "L," offers a different set of benefits, fills different "gaps" in Medicare coverage, and varies in price and out-of-pocket costs

13. Foreign Travel Emergency/ Medicare and Medigap Plans • Medicare does not cover any health care received outside of the U.S. • Medigap Plans C through J cover some emergency care outside the U.S.

14. Medigap Plans and Foreign Travel Emergency Covered by Plans C-J After a yearly $250 deductible is met, Medigap Plans C-J will pay: • 80% of the cost of emergency care during the first 60 days of the patient’s trip • There is a $50,000 lifetime maximum

15. Which Company Should Patients Buy Travel Insurance From? • There are over 15 companies in the travel insurance business, and each one sells a variety of plans • These are easily found through an Internet search for medical travel insurance

16. How Much Should Travel Insurance Cost? • This depends on the type of plan, the coverage, and other factors • In general, a Package Plan will cost between 5-7% of the total trip cost • So, if the total insured trip cost is $5,000, a package plan would be around $250-350 (5-7% of $5,000)

17. Travel Medical Coverage Can Provide Coverage for Medical Expenses Such as: • Transportation to the hospital • The services of a physician • Charges for hospital stays and operating rooms

18. Travel Medical Coverage also Provides Important Benefits for Emergency Medical Evacuation • Oftentimes, special medical flights, or “evacuations”, are required to get an injured or sick traveler back to their home country • Medical evacuations can easily cost ten’s of thousands of dollars, and in some cases upwards of $100,000

19. EXAMPLE Policy #  2620975 PROTECT ASSIST 306700   P1  3/2007 Coverage effective date 06/19/2008 Total cost $120.00 Trip details Departure date 06/20/2008 Return date 07/01/2008 Trip deposit date Contact Information Traveler #1 Insured on Policy Trip Cost Traveler #1 $2,000.00 Selling Agency Agency “X Phone:   "Prex waiver applies to the first $30,000 of trip cost. Only valid if prex requirements are met." Coverages & Benefit Limits Standard Packages ACCID & SICKNESS MED EXP $25,000.00/Insured AIG TRAVEL ASSIST -- Per Insured BAGGAGE & TRAVEL DOCS $1000.00 Per Insured BAGGAGE DELAY $300.00 Per Insured CONCIERGE SERVICES -- Per Insured EMERG MED TRANS $500,000.00 Per Insured ID THEFT ASSIST SVCS -- Per Insured LIVETRAVEL ASSISTANCE -- Per Insured MISSED CONNECTIONS $250.00 Per Insured TRAVEL DELAY $750.00 Per Insured $150.00 Payout Limit Per Day TRIP CANCELLATION 100% Trip Cost Per Insured TRIP INTERRUPTION150% Trip Cost Per Insured TRIP INTERRUPTION - RET AIR $750.00/Insured Optional Packages Optional Umbrella Package ACCID DEATH/DISMEM $25000.00 / Insured EMERG MED TRANS $500,000.00 / Insured MED COV UPGRADE $25,000.00 Per Insured

20. EXAMPLE Policy #  2620969 PROTECT ASSIST 306700   P1  3/2007 Coverage effective date 06/19/2008 Total cost $154.00 Trip details Departure date 06/20/2008 Return date 07/01/2008 Trip deposit date Contact Information Traveler #2 Insured on Policy Trip Cost Traveler #2 $2,000.00 Selling Agency Agency “X” Phone:   "Prex waiver applies to the first $30,000 of trip cost. Only valid if prex requirements are met." Coverages & Benefit Limits Standard Packages ACCID & SICKNESS MED EXP $25,000.00/Insured AIG TRAVEL ASSIST -- Per Insured BAGGAGE & TRAVEL DOCS $750.00 Per Insured BAGGAGE DELAY $250.00 Per Insured CONCIERGE SERVICES -- Per Insured EMERG MED TRANS $500,000.00 Per Insured ID THEFT ASSIST SVCS -- Per Insured LIVETRAVEL ASSISTANCE -- Per Insured MISSED CONNECTIONS $250.00 Per Insured TRAVEL DELAY $1500.00 Per Insured $150.00 Payout Limit Per Day TRIP CANCELLATION 100% Trip Cost Per Insured TRIP INTERRUPTION 100% Trip Cost Per Insured TRIP INTERRUPTION - RET AIR $750.00/Insured Optional Packages Optional Umbrella Package ACCID DEATH/DISMEM $25000.00 / Insured EMERG MED ASST & REPATRIATION --/Insured EMERG MED TRANS $500,000.00 Per Insured

21. Coverages & Benefit Limits TRAVELER #1 Standard Packages ACCID & SICKNESS MED EXP $25,000.00/Insured AIG TRAVEL ASSIST -- Per Insured BAGGAGE & TRAVEL DOCS $1000.00 Per Insured BAGGAGE DELAY $300.00 Per Insured CONCIERGE SERVICES -- Per Insured EMERG MED TRANS $500,000.00 Per Insured ID THEFT ASSIST SVCS -- Per Insured LIVETRAVEL ASSISTANCE -- Per Insured MISSED CONNECTIONS $250.00 Per Insured TRAVEL DELAY $750.00 Per Insured $150.00 Payout Limit Per Day TRIP CANCELLATION 100% Trip Cost / Insured TRIP INTERRUPTION 150% Trip Cost / Insured TRIP INTER - RET AIR $750.00/Insured Optional Packages Optional Umbrella Package ACCID DEATH/DISMEM $25,000.00 / Insured EMERG MED TRANS $500,000.00 / Insured MED COV UPGRADE $25,000.00 / Insured Coverages & Benefit Limits TRAVELER #2 Standard Packages ACCID & SICKNESS MED EXP $25,000.00/Insured AIG TRAVEL ASSIST -- Per Insured BAGGAGE & TRAVEL DOCS $750.00 Per Insured BAGGAGE DELAY $250.00 Per Insured CONCIERGE SERVICES -- Per Insured EMERG MED TRANS $500,000.00 Per Insured ID THEFT ASSIST SVCS -- Per Insured LIVETRAVEL ASSISTANCE -- Per Insured MISSED CONNECTIONS $250.00 Per Insured TRAVEL DELAY $1500.00 Per Insured $150.00 Payout Limit Per Day TRIP CANCELLATION 100% Trip Cost Per Insured TRIP INTERRUPTION 100% Trip Cost Per Insured TRIP INTER - RET AIR $750.00/Insured Optional Packages Optional Umbrella Package ACCID DEATH/DISMEM $25,000.00 / Insured EMERG MED ASST & REPATRIATION --/Insured EMERG MED TRANS $500,000.00 Per Insured

22. 10 Questions to Ask When Buying Travel Medical Insurance

23. Plans and policies vary greatly. Ask for a printed copy outlining exactly which emergency medical treatment and/ or medical evacuation and transport services are provided.

24. 2. Ask about a waiver of any pre-existing medical conditions exclusion.

25. 3. What type of emergency medical evacuation transport service is provided? • Not all M.E.T services are the same! • Some offer worldwide travel medical evacuation that will transport the patient home or to the hospital of their choice, plus cover any qualified accompanying travel medical expenses incurred • Other plans only cover evacuation and transportation to the nearest adequate medical facility

26. 4. Ask if there are any deductibles or copayments. • Are there charges for treatments, exams and tests? • Are there charges for drugs, medicines and other services and supplies?

27. 5. Find out if all coverages are primary. Will the insurance company pay foreign hospitals and foreign doctors directly or will the patient have to pay out-of-pocket and be reimbursed later?

28. 6. Will they refill lost prescriptions?

29. 7. Will the plan cover on-going medical expenses? Many plans will cover necessary medical expenses up to one year after the sickness or injury, provided injury or sickness occurred while on the trip and the patient received initial treatment while on their trip.

30. 8. Do they offer 24/7 emergency assistance for anywhere in the world? • When in a foreign country, there are several potential problems in the event of a medical emergency. • The patient might not speak the language • They probably won’t know where the hospital is • They may not be able to communicate with the • doctor • They won’t know if the hospital can provide • adequate care

31. 9. Do they have live messaging? Will they relay e-mail or phone messages to the patient’s family, friends or business associates?

32. 10. Know the policy’s General Exclusions. In addition to any other exclusions that may apply to a particular benefit.

33. Prepare & Pack Medications & Medical Equipment & Filling Prescriptions Abroad • Carry a letter from the attending physician, describing preexisting medical condition and any prescription medications • All medications carried overseas should be clearly labeled in their original container • Verify with the foreign embassy of the destination country that all required medications are legal • Take duplicate copies of prescriptions (in generic names) • Carry your drugs on board rather than packing them in luggage • Carry a sufficient quantity of required medications and inhalers. Certain locations such as China & Mexico may have pollution problems in major cities & may pose special risks for the individual with lung disease. • Carry a supply of medication for the recurrences of bronchitis. The antibiotics that are customarily taken for bronchitis may not be available in destination

34. Prepare & Pack Medications & Medical Equipment & Filling Prescriptions Abroad • Obtain a special filtration mask and avoid outside exposure when pollution, humidity, and pollen are severe in areas of travel • Check with a physician about the advisability of traveling while using a respirator • Check voltage/amperage in destination locations (if a respirator is used) to make sure there are proper power transformers • Carry some medical alert information, preferably a Medical Alert wristband containing the diagnosis of pulmonary disease. Also include a history of any known allergies or sensitivities, especially to medications • If possible, obtain the names and contact information of physicians and preferred medical facilities in the destination cities, in case complications should arise.

35. Prepare for the Destination’s Climate and Air Quality • Before leaving, look in the paper, on TV, or online to find the local weather and air quality conditions • Anticipate respiratory triggers that might be at the new destination: will there be pollen or air pollution? Will it be extremely cold, extremely hot, or humid? • plan to cope with these triggers

36. Pace Themselves! • Don't do too much, or they may get run down and vulnerable to infections and flare-ups • Get enough sleep, especially if they’ve crossed time zones and are coping with jet lag • Remember to eat well; too much food may make breathing more difficult • High altitudes may also change how alcohol affects them • In short: take it easy, and their trip will be more enjoyable!

37. People with Disabilities are a Powerful and Growing Segment of the Population According to the U.S. Census Bureau’s 2002 Survey of Income and Program Participation (SIPP) there are 51.2 million Americans with disabilities.

38. Let’s Put That Into Perspective… • The 2002 SIPP indicated that the U.S. population’s percentage of people with disabilities was 18.1% • That is larger than the percentage of Hispanics in the U.S. population (13.3%), the country’s largest ethnic, racial, or cultural minority group

39. Diversity Within the Disabled Population • Each U.S. ethnic, racial, and cultural group has members with disabilities • The 2002 SIPP reported that at least 11.5% of each of these groups self-identified as having disabilities For example: Black Americans reported 19.8% Hispanics/Latinos reported 13.8% Whites reported 19.0% Asians or Pacific Islanders reported 11.5%

40. Spending Power of Americans with Disabilities • The growing market of people with disabilities has $175 billion in discretionary spending, according to the U.S. Department of Labor • $175 billion is more than four times the spending power of “tweens” (8-14 year-olds), a demographic sought after by businesses • An Open Doors Organization study estimated in 2003 that diners with disabilities would spend $35 billion in restaurants that year • The New York Times reported that spending by travelers with disabilities exceeds $13.6 billion annually

41. Examples of the Global Spending Power of People with Disabilities Include: In 2005 that there were approximately 10 million adults with disabilities in the UK. The estimated annual purchasing power of people with disabilities there is £80 billion Canada reported in 2001 that the combined annual disposable income of working-aged Canadians with disabilities is CAN $25 billion

42. Global Population of People with Disabilities The World Health Organization (WHO) estimates that there are 600 million people with disabilities around the world

43. Collective Voices of People with Disabilities and Their Allies Around the World Have Been Strong and Persistent • At least 40 countries have adopted legislation addressing the rights of persons with disabilities. • Some of this legislation prohibits discrimination as its primary goal; other laws address the positive duty of the State and the community to ensure the welfare of persons with disabilities and their access to social support • Many countries have both types of legislation

44. The United Nations • In December 2006 the United Nations adopted The Convention on the Rights of Persons with Disabilities • The Convention is the first comprehensive human rights treaty of the 21st century. As of November 2008, 41 countries have ratified the Convention; many more countries have been signatories indicating they are likely to ratify the treaty • The Convention on the Rights of Persons with Disabilities was historic in a number of ways – it was the fastest negotiated human rights treaty and had the highest number of signatories on its opening day in U.N. history

45. Laws and Conditions “On the Ground” Vary from Country to Country… So Know Your Rights! For example…

46. The Americans With Disabilities Act • The Americans with Disabilities Act (Pub. L. 101-336) (ADA) was signed into law on July 26, 1990 and was amended (P.L. 110-325) in 2008, with changes effective January 1, 2009 • The ADA is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability

47. Other Countries Disabilities Acts A number of countries have passed laws prohibiting discrimination on the basis of disability since 1990, and the model of the ADA certainly influenced many of these laws • For example, Australia passed a Disability Discrimination Act in 1992, and Great Britain enacted its Disability Discrimination Act in 1995 • Each of these laws was affected, to a greater or lesser extent, by the U.S. enactment of the ADA, and borrowed concepts and language from it Journal Article Excerpt: Disability Rights in the USA and Abroad - Robert L. Jr. Burgdorf

48. Other Countries Disabilities Acts The British and Australian laws illustrate, however, that various nations have followed very different paths in passing laws that can be loosely considered "ADA-like" • The Australian Disability Discrimination Act is extremely comprehensive, forceful, and specific • The British version of a Disability Discrimination Act, in contrast, is much less broad, specific, and substantial than the ADA Journal Article Excerpt: Disability Rights in the USA and Abroad - Robert L. Jr. Burgdorf

49. The key to a safe and enjoyable trip is preparation and planning!

50. Thank You! Debra Karstadt for your invaluable research and help with this presentation