|Bit of an update on this, as I'm sorting out insurance for a trip to the USA for climbing this year. Seems the market changes quite fast, so people might find this useful.
My requirements - trad climbing trip for 3 weeks to USA, nothing higher than 14000ft / 4250m. Want to get emergency evacuation and at least $250k medical treatment cover in case of climbing accident requiring hospitalisation. I'm 49, no preexisting conditions. These are the options I found:
1) Global Underwriters Diplomat America with Athletic Sports & Hazardous Activity Rider (middle option - Mountain Climbing 14,000 ft. & below - Ropes & proper safety equipment required). Cover: Medical $500k, Evacuation & Repatriation $500k, Corpse repatriation $50k, Family attendance $50k, Death & Disability $25k, some very limited other benefits. Deductible $250. Premium $125. (All prices in USD) Comments - seems to be very decent cover for medical emergency from rock climbing - would need to have normal travel insurance as well, but might be good enough for some people together with travel insurance that comes free with credit card bookings.
2) Austrian Alpine Club insurance - looks good for covering emergency repatriation and some hospital costs - cheap for long term coverage - would be excellent for someone wanting annual coverage for global climbing disaster insurance - but does not cover the massive bills you can incur in USA medical system, so not appropriate for me.
3) Insure4less - lots of recommendations for this on Chocky, with the proviso that it has been getting very expensive recently. On checking it out I read that "There is no cover for Mountaineering, trekking or trad climbing in the USA or Canada." So they no longer offer trad / alpine climbing cover for the USA - no use to me.
4) Patriot Adventure America - looks quite decent at first - one month insurance for medical, covers adventure sports including rock climbing, $149 premium for max $50,000 cover. But with a bit of research, $50k cover doesn't look anywhere near enough for the USA - and fine print of the climbing section repeatedly refers to exclusions if "proper ropes and guides" are not used - so not suited to self-guided climbers.
5) Virgin Money Travel Insurance with Adventure Pack (includes "Outdoor rock climbing (with ropes and appropriate safety gear)". General travel insurance for this period costs $110 for unlimited medical and emergency assistance, and when the Adventure Pack is added, costs $140, so not much of a bump. It does not include rescue costs - but as we are climbing in Yosemite National Park, YOSAR provide free rescue services if required. Virgin is underwritten by Allianz Global, who are a huge global insurance company. Their AU office offers similar insurance, but their front end process was more difficult and I couldn't find / select the Adventure Pack to compare pricing. As this insurance combines general travel & medical insurance and includes rock climbing as a permitted activity, it is the best insurance for my purposes.
Given all these options, the Virgin pack works for me. Please read the various PDS and consider your own needs, this is not advice but just some notes on my own research. Hopefully it is helpful in updating this thread.