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Medical Travel Insurance USA

You may be aware that medical treatment in the USA is expensive. If you travel without comprehensive travel insurance for the USA, it means you have no protection if you require treatment on your trip. Travelling without insurance puts you at huge risk as medical bills in the USA frequently run into tens of thousands of pounds.

Travelling to the USA but confused by tipping and etiquette?

Our tips may help, but please note that this is just a Guide and may not apply in all situations.

Tipping is not mandatory in the United States

In some places a clearly displayed “Service Charge” might be added to a bill, especially for party sizes of 8 or more. 

Always leave tips in cash

Handing them directly to the person you are tipping, whenever feasible. This makes certain that the right person is rewarded.

General rule

15% usually means all was ok, 20% for excellent, and 25% for outstanding. Don’t tip poor service – let someone know you were unhappy, even if you just leave a note to the server as to why there is no tip added to the bill. Outstanding service can include, especially prompt or friendly, or the server fulfilled many special requests.

Restaurants with table service

Tip 15% of the bill, based on the quality of service. If you receive exceptional service, 15-25% is customary. In major cities of the U.S. however, 20% is considered to be a “good tip”. At higher end restaurants, there may also be a sommelier or wine steward. You should tip the sommelier separately, at your discretion.

Buffet restaurant

tip of 15% to 20% of the bill is still recommended because the servers often work harder than in normal restaurants. They may not take orders or bring out food, but they do work hard keeping your table clean of the empty plates after multiple trips to the buffet line. In addition to this, they often help to keep the buffet line stocked and clean, and they make coffee, brew tea, etc. 

Counter service/fast food restaurants

often have tip jars out, but you are not required to tip. If the service is exemplary or unusual requests are made, then tips are appropriate. 

Bar tenders

$1 – $2 per drink, or 15-20% of the total bill. If you tip well and consistently at bars and pubs, you are likely to receive a drink on the house, known sometimes as a “buy back.” This typically occurs after the 3rd drink you buy. Even though the drink is free – Don’t forget to tip on the “buy back.”

Other optional tipping situations common to travellers in the USA

Hotel housekeeping/maid service

$2-3 per night up to $5, more in high-end hotels. Also more if there are more than 3 people in a room or suite. Leave the tip on your pillow or in a similar obvious place with a note that says thank you. Leave the tip each day when you leave the room, rather than at the end of your stay, because your room might get cleaned by different people each day, depending on staff schedules. If you have additional items delivered to your room, such as extra pillows, hangers, luggage racks, tip the person who brings them $2 or $3. 


Tipping is never expected, but always appreciated. The more difficult the request, the higher the tip. $5.00 and up per request is good.
In-suite dining waiter: Always read the bill, if there is a tip included, it will be on the bill breakdown. The policy of having the gratuity included in the bill is not the norm anymore. A service charge or convenience fee goes to the hotel, not the server. If there is no gratuity added, tip the server 15% – 20%. 


$1-2 per bag. More if the bags are very heavy. 

Taxi driver

10-15% of fare, based on service. 

Hotel limo driver

For a free ride from the airport, $10 – $20 

Valet parking attendants

$2 – $5 (when picking up car). 


For a massage or other treatment, 10% – 20%. Ask if the tip has been included, some spas will include a gratuity on your final bill. Most spas will provide you with an envelope to leave at the reception desk for the person who gave you your treatment. Also, if you wish to leave a small gratuity for the spa attendant who showed you around the Spa and got you situated, it is well appreciated, $2 to $5.


10% – 20%.

Tour guides

15% – 20% + depending on quality (knowledge, friendliness, etc)



If you wish to contact us about this policy or you have any other questions, please telephone us during office hours, 9am to 5pm, Monday to Friday, on 01592 858386 or click here to complete the contact us form ».

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