If you have any onboard medical attention, they put the amount owed on your sign/sail card which will be charged to your credit card. You then have to send in your claim along with all the paperwork and charges. First you use your regular health care and what that doesn't cover, you file a claim with your travel insurance carrier.. Yes, this takes time, but with the added coverage, could save you a lot of heart ache and dollars...Always get the insurance, figure it as part of cruising or taking a vacation.