I took out the VHI top-up for €49 per year. The benefits seem to be more than adequate. Having made a number of claims on travel insurance over the years - from lost luggage, stolen items, medical treatments etc - I will highly recommend having it. When you really need it you will be glad.
If going with some of the other online providers, check who their underwriters are and make sure they are a known company, accredited etc.
Before my VHI policy I used to use Goinsure and get the top level policy. This covered me in all countries (including US and Canada), had no excess for claims and increased liability and health coverage. I also found them pretty OK to deal with. Paying that little extra for no excess can pay itself back in the event of even one claim.
Bluemac - Sorry to hear your troubles in claiming, but unfortunately when you accept the T&Cs of the policy this is all laid out in it. I think it's silly not having insurance if going away. You really never kknow what is going to happen. It's not just the cost of flying home though. I had to have emergency antibiotics from a coral infection while in Australia and they were expensive, plus the cost of having cameras down your nose and throat in a reputable Asian hospital is not comparable to the living costs of being in that country. Other bemefits protect your family - if you are ill a relative will be flown out to you in many cases, and is it fair that you are stuck in a foreign country, possibly serious injury/illness, while your loved ones have no communication?