You don’t need insurance to pay for air/sea rescue because that service is provided by the Coast Guard or military equivalent from the nearest country capable of providing it. They are the ones with the equipment and skilled personnel to perform such a maneuver.
There is no cost. It is part of their mission to aid ships at sea. Your cost begins when the helicopter touches down. Travel insurance covers transportation and care from that point.
If air/sea rescue is not available, the ship diverts to the nearest port to disembark the patient.