Nepal Trekking Insurance 2026: What You Must Have (and What's Useless)

I book helicopters for sick trekkers more often than I would like — from Pokhara it is usually the Annapurna side, from our Kathmandu desk it is the Khumbu. And the pattern is always the same: the flying is arranged in twenty minutes, and then the argument with the insurer starts. So let me tell you, as the person who actually makes the calls, exactly what to buy and what is a waste of money.

Why standard travel insurance is not enough

Most off-the-shelf travel policies exclude trekking above a certain altitude — often 3,000m or 4,000m — which rules out almost every classic Nepal trek. Read the fine print before you assume you are covered. A policy that says "hiking included" and one that says "trekking to 6,000m including helicopter evacuation" are not the same product, and the cheap one is worthless the moment you need it. The exclusion is rarely on the front page; it lives in the schedule under "hazardous activities."

The four things your policy must cover

1. Altitude: Confirm coverage to the maximum altitude of your trek. EBC reaches 5,545m at Kala Patthar; Thorong La on the Annapurna Circuit is 5,416m; Island Peak is 6,189m and counts as mountaineering, which needs a separate, more expensive tier — a trekking policy will not touch it.

2. Helicopter evacuation: The single most important clause. A helicopter rescue from 4,000–5,000m costs USD 3,000–8,000, and as much as USD 15,000 once you add the hospital transfer and repatriation. Your policy must explicitly cover emergency helicopter evacuation — not "medical transport," which an insurer will argue means an ambulance.

3. Medical treatment & repatriation: Treatment in a Kathmandu hospital (CIWEC or Norvic are the ones we use) plus a medical-escort flight home can run into tens of thousands of dollars. Aim for at least USD 100,000 of medical cover and confirm repatriation is included, not an add-on.

4. Trip cancellation: Flights into Lukla and Jomsom cancel constantly for weather — three days grounded in Lukla in October is routine, not bad luck. Cover lost nights, rebooking, and the knock-on cost of a missed international flight.

What "enough cover" looks like by trek

Match the policy to the route, not to a generic "Asia, 2 weeks" template. This is the table I wish every client read before they bought:

Trek	Max altitude	Min altitude clause	Heli-evac essential?	Notes
Ghorepani / Poon Hill	3,210m	3,500m+	Strongly advised	Low ceiling, but you still want the evac clause
Annapurna Base Camp	4,130m	4,500m+	Yes	Fast ascent up the Modi Khola — AMS is real here
Everest Base Camp	5,545m (Kala Patthar)	6,000m	Non-negotiable	Highest AMS evac rate of any teahouse trek
Annapurna / Manaslu Circuit	5,416m / 5,106m	5,500m+	Non-negotiable	A pass day with no bail-out point for hours
Island / Mera Peak	6,189m / 6,476m	6,500m + "mountaineering"	Non-negotiable	Trekking policies exclude this — buy the climbing tier

Recommended insurers for Nepal

Specialist adventure insurers such as World Nomads, Global Rescue, the Austrian Alpine Club (ÖAV), the British Mountaineering Council (BMC), and Snowcard are built for high-altitude trekking rather than beach holidays. Always declare your maximum altitude and whether you are peak-climbing. Global Rescue and Ripcord are the ones designed around the evacuation itself rather than reimbursing you afterwards — worth it if you are on a big objective. The ÖAV/Alpine Club membership route is often the cheapest legitimate option for European trekkers and covers the whole season, not one trip.

Pre-existing conditions

Declare everything. An undeclared condition voids the entire policy — including unrelated claims. If you take regular medication, carry it in original packaging with a doctor's letter. Insurers in this space are strict but fair: a declared, stable condition is almost always covered, whereas the same condition hidden gives them a clean reason to refuse a USD 12,000 evacuation invoice.

How a real rescue actually gets paid

Here is the part nobody explains. When we call a helicopter for you, the operator wants a guarantee-of-payment before the rotors turn — that is where your insurer's 24-hour emergency line matters more than the policy document. Save that number in your phone and write it on paper in your pack. Keep the policy number with it. A good policy with a dead phone line at 3am is no policy at all. This is also why we ask every client for their insurer and emergency number at the pre-trip briefing: so we are not hunting for it while you are struggling to breathe.

What a claim actually needs

If it does come to a claim, the paperwork decides whether you are reimbursed or refused. Keep every receipt — the helicopter invoice, the hospital bill, the pharmacy slips. Get a written diagnosis from the treating doctor in Kathmandu (CIWEC and Norvic issue proper reports in English) and, if you were evacuated, ask the rescuing operator for the flight documentation. Photograph everything before you leave Nepal, because chasing a Kathmandu clinic for a duplicate invoice from another continent is miserable. File within the window your policy states — often 30 days — and route it through the same 24-hour line that authorised the rescue, so the case number matches. Trekkers who keep clean records almost always get paid; the ones who lose the paperwork are the horror stories you read online.

Who this guide is NOT for

• Day hikers around Pokhara or Kathmandu. If you are staying below 3,000m — Sarangkot, Australian Camp, the valley rim — a standard travel policy is genuinely fine. Do not over-buy.
• Peak climbers expecting a trekking policy to cover them. Island Peak and Mera are mountaineering. You need the climbing tier or a specialist expedition policy — full stop.
• Anyone who thinks insurance replaces acclimatisation. A policy pays for the rescue; it does not stop the altitude sickness. The cheapest evacuation is the one you avoid by walking slowly and sleeping low.

Bottom line

Trekking in Nepal without helicopter-evacuation insurance is the single biggest avoidable risk a trekker takes. The premium difference for proper coverage is small; the downside of going without is catastrophic. Get the altitude and the heli clause right, declare your health honestly, and carry the emergency number on paper.