Southern Cross travel insurance has revealed a list of the top 10 most expensive places for Kiwi travellers to fall ill.
As expected the United States' privatised healthcare is top of the pile, however the country with the second biggest group of medical bills might surprise you.
Australia is the second biggest source of medical bills for Kiwi travellers.
This news might come as a surprise considering New Zealand has a reciprocal agreement with Australia's public health service. Kiwis – like Australian's holidaying over here – are covered by emergency public medical care.
However, things such as extended hospital stays or medical evacuations are not necessarily covered by public health agreements – which can add up to a sizeable bill.
While the average medical bill per traveller is lower than in other countries (averaging only $555) the proximity and popularity of Australia as a holiday destination makes it a big source of medical bills for travellers.
One of this year's largest payouts by Southern Cross in Australia was for a woman who had to be flown home following surgery for a spinal abscess. The 68-year-old faced an eye-watering $14,670 bill for expenses not covered by the ACC agreement.
"Some of the highest claims we receive are for tourists requiring extended accommodation for recovery, or medically-assisted travel back home. The knowledge that these costs [extra to reciprocal agreements] can be covered by travel insurance is a huge relief to travellers suffering away from home," said Chris White, CEO of Southern Cross Travel Insurance.
According to White the many "compounding factors" of medical treatment overseas can cause added stress to travellers who fall sick overseas. Even when there is some sort of access to publicly funded assistance the situation can be complicated by "being away from a familiar home environment, not speaking the language, and not knowing the local healthcare system."
The United Kingdom, another country with which New Zealanders benefit from reciprocal health care, came in as the fifth most expensive for travellers' medical bills.
New Zealand has no such agreement with Italy, which came in as the third on the table for emergency health costs.
This year's unusually high total for Italy was, in part, due to one extreme case in which a New Zealand cruise passenger fell ill and had to be transferred to a hospital. The 70-year-old traveller was faced with a $123,764 bill for bowel surgery, hospital stay and transfers.
MFAT advises travellers to Italy that "private healthcare is required for emergency and non-emergency treatment".
Doctors' fees in Italy are generally higher than in New Zealand, with the average costs for a 7 day stay in hospital coming to Euro 3500 or just under $6000.
However, far ahead of any other claim was a payout for $370,000 for the treatment of a 77-year-old cruise passenger in USA who underwent emergency heart surgery to replace an aortic valve.
Most expensive places to fall ill on holiday
5. United Kingdom
Source: Southern Cross total payouts by country
When it comes to the average claim by destination the US's $4753 looks quite moderate compared to Israel's $20,600.
However, considering Israel recorded only 400 visitors from New Zealand between January and November this year, one presumes a few of these Kiwi travellers were particularly unfortunate. According to Yale University's Fox Yale Fellowship the cost of health care in Israel is approximately half of that in the US.
While Australia relatively small average claim of $550 would suggest that Kiwi travellers are submitting smaller claims for things not covered by reciprocal health cover, the UK has a remarkably high average claim.
Visitors to the UK are claiming over $2000 per incident. While some of this could be due to travellers opting for private treatment, this large sum would suggest that ACC's reciprocal agreement with the NHS is not quite as robust as many travellers presume.
The Ministry of Health warns holiday makers to the UK and Australia that public health agreements are not comprehensive and travellers are advised to take out separate policies:
"As neither reciprocal agreement provides full coverage, travellers should hold comprehensive travel insurance, including health insurance."
Average claim by destination
1 Israel $20,600
2 United States $4753
3 Italy $3419
4 Spain $2483
5 United Kingdom $2296
6 China $2125
7 Indonesia $2090
8 Canada $1858
9 Thailand $1115
10 Australia $555
Southern Cross has been asked for further comment regarding these average claims