Travel insurance for Saint Helena is not just advisable, it is a legal requirement, and it is one of the few destinations that will not let you in without it. Saint Helena is one of the most remote inhabited islands in the world, a British territory in the South Atlantic, and its isolation is the reason the rules around insurance are so strict. Before you travel, you need cover that specifically meets the island's requirement.
Insurance is required by law
Visitors to Saint Helena are required by law to hold medical insurance of at least 175,000 pounds, or the equivalent, that covers emergency medical treatment including aeromedical evacuation and repatriation to your home country if you become seriously ill. This is not a formality: because a serious case has to be flown off the island, the authorities want proof that the cost is covered before you arrive. Make sure your policy explicitly meets that figure and includes aeromedical evacuation, and carry the documentation.
Remote care and evacuation
Saint Helena has one hospital, in Jamestown, along with local clinics, but the facilities are basic and cannot handle complex cases. For a serious medical emergency, evacuation, typically to South Africa, may be required, and that is expensive and logistically difficult from a mid-Atlantic island. Hospitals and practitioners on the island generally require payment up front, even if you hold insurance, so you claim the cost back afterwards. That makes a policy with a high evacuation and repatriation limit essential.
Getting there, and delay cover
Saint Helena Airport opened to commercial flights in 2017, replacing a five-day ship voyage from Cape Town with a flight of around six hours from Johannesburg, but there is typically only one flight a week. That makes travel disruption a real risk, so it is worth choosing a policy that also covers missed and delayed departures. Buy the cover before you leave home, confirm it meets the island's legal minimum, and keep the documents with your travel papers, because you may be asked to show them.