AMEX has many offers. They are not all created equal. You get what you pay for in most cases and in this case your credit score and background will come into play. Better credit can reflect risk and behavior habits. My family has no limits on evac costs and no activity limits nor a preexisting condition clause. Scuba Diving and Sky Diving are covered or at least not excluded.

The rub if there is any... the fine print says the travel must be charged to AMEX and your card must be current i.e. you are not behind paying your bills. If a child jumps in a college road trip car they may not be covered. If you use miles with no charges to the card you may not be covered. There is some history of AMEX covering trips as long as another card was not used for the travel. 90 days in the same place no longer becomes "travel" in my agreement. The BVI only lets me stay 30 days so no worry there.