Last Updated on September 30, 2023 by Michael


Are you a non-U.S. citizen renting a car in the United States? If so, your rental car company may offer an insurance option called Emergency Sickness Protection (ESP). Don’t fall for it.

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Instead, before you travel to the U.S., take out travel insurance that includes coverage for medical expenses abroad. Otherwise, know that there are no reciprocal health care agreements in place for visitors to the USA from foreign countries.

What happens if you have no insurance? You can get medical treatment in the U.S., but you will have to pay for it in full. American medical fees can be extremely high compared to other countries. The final bill for treating a common injury such as a broken ankle can run into thousands of dollars.

What is Emergency Sickness Protection in a Rental Car?

ESP is an insurance product offered by some rental car companies. It theoretically provides sickness protections for international visitors to the US. It’s offered by a third party, which typically charges the rental car company 75 cents per rental day. In turn, the rental car company can then charge $3 or more per day to the renter. That’s called gouging.

It’s a markup that’s fantastic for commissions, so the agents at the counter are highly motivated to sell. But this insurance will duplicate coverage you already have through your travel insurance policy.

Fine print for Emergency Sickness Protection

Even worse, the typical Terms and Conditions shows many exclusions in which a claim could be denied.

  • Any illness that starts before or after the rental
  • Any pre-existing condition
  • Vision, dental, or hearing coverage
  • Any form of accident
  • Participation in organized sports
  • Cardiovascular diseases, including heart attacks and strokes
  • Cancer or tumors
  • Congenital conditions
  • STDs
  • Anything related to pregnancy
  • Travel against physician orders
  • Travel to seek medical care

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Companies Offering Emergency Sickness Protection

The Enterprise Holdings Companies (Alamo, Enterprise, and National) plus Sixt don’t even bother to offer Emergency Sickness Protection. We consider that a customer-friendly position.