Most travellers buy insurance, tick a box and never open the document. For a beach holiday that is usually fine. For Peru it is not, because the single most common exclusion is the one that describes exactly what you came to do.

This is not about recommending a company. It is about the five things to look for in whatever policy you are considering.

1. The altitude limit, the one that catches everyone

Many standard policies cover hiking only up to 2,000 or 3,000 metres. Some go to 4,000 or 4,500. Above the stated limit, you are simply not covered.

Now compare that with where you are actually going. Cusco itself sits at 3,400 metres, so you are above some limits before you have walked anywhere. The Dead Woman's Pass on the Inca Trail is 4,215 metres. Rainbow Mountain is around 5,000. The Palomani pass on the Ausangate circuit is roughly 5,200.

Find the altitude figure in the policy wording. If there is no figure, that is not good news, it means you have to ask and get the answer in writing.

2. Trekking versus mountaineering

Insurers separate walking on marked trails from anything involving ropes, crampons or ice axes. Trekking in Peru is the first category: the Inca Trail, Salkantay, Lares and Ausangate are all walking, however hard they feel.

The problem is that some policies classify anything above a certain altitude as mountaineering regardless of technique, and price or exclude it accordingly. Check how your route is classified, not just whether hiking is covered.

3. Helicopter evacuation and repatriation

This is the clause that matters most and gets read least. On a trek there are stretches where the only way out for a serious problem is a helicopter, and that is expensive.

Look for explicit mention of emergency evacuation, mountain rescue and repatriation, with the amount covered. A policy that pays hospital costs but not the evacuation to reach the hospital solves the cheaper half of the problem.

4. Cancellation, and what actually gets refunded

Inca Trail permits are non-refundable and non-transferable. If you cannot travel, that money is gone unless your insurance covers it.

Check the list of accepted reasons for cancellation, whether the permit itself counts as a covered prepaid expense, and what documentation is required. The gap between what people assume and what is written here is usually large.

5. The exclusions nobody reads

Pre-existing conditions almost always need to be declared, and declaring them tends to be cheaper than the alternative of not being covered.

Altitude sickness itself is sometimes excluded, which is worth checking given where you are going.

Alcohol is a common exclusion: an accident where alcohol is involved may void the claim entirely.

And electronics have their own limits and rules, which matter if you carry a camera worth more than the rest of your luggage.

Practical advice

Buy the insurance when you book, not the week before you fly. Cancellation cover only protects what it covers from the moment it starts.

Carry the policy number and the emergency phone number offline, on paper or as a screenshot. There is no signal on the trail, and that is exactly when you would need it.

Leave a copy with someone at home, and give your operator the emergency contact details before the trek starts.

If a policy does not clearly state its altitude limit in writing, treat that as a reason to keep looking rather than a detail to sort out later.

Reviewed August 2026. Policy terms change; always read the current wording before buying.