What OHIP Covers When Travelling Outside Ontario
If you’re an Ontario resident planning a trip outside the province, understanding your health coverage under the Ontario Health Insurance Plan (OHIP) is crucial. OHIP, the publicly funded health insurance plan for Ontario residents, provides extensive coverage within the province. But what happens when you travel outside Ontario?
At Cross Country Valet, many of our Ontario-based clients are either snowbirds with winter homes down in the United States, or summer vacationers with cottages in other provinces. For such people who spend significant amounts of time each year out-of-province, understanding the implications on health insurance coverage is crucial for avoiding unexpected hospital bills.
Here’s a comprehensive look at what you need to know about OHIP coverage when you’re out of the province. This information was largely adapted from the Government of Ontario website, so we recommend visiting there if you require more detail.
OHIP Coverage in Other Canadian Provinces and Territories
When you travel to other provinces and territories within Canada, OHIP generally covers you. Thanks to reciprocal agreements between provinces and territories, your hospital and physician services are billed directly to OHIP, just as they would be in Ontario.
For example, if you need hospital care while in another province or territory, OHIP covers the cost of insured services. This includes emergency care, necessary medical procedures, and hospital stays. You won’t need to pay out-of-pocket for these services as long as they are medically necessary and covered by OHIP.
Similarly, visits to a doctor or specialist are also covered by OHIP. If you need to see a physician, the bill will typically be sent directly to OHIP for payment. It’s advisable to show your valid OHIP card to healthcare providers to facilitate this process.
What is Not Covered When You Are in Other Provinces?
When traveling to other Canadian provinces or territories, it’s important to know that some services are not covered by OHIP, including:
- Services Not Covered in Ontario: This includes procedures like cosmetic surgery, which are not deemed medically necessary.
- Ambulance Services: This covers both the transport and the paramedic services.
- Prescription Drugs: Medications obtained outside a hospital setting are not covered.
- Home-Care Services: Any home-care services you might need are not covered.
- Private Hospital Fees: Charges from private hospitals or healthcare facilities are not covered since they are outside of the public system.
- Diagnostic or Laboratory Services: Likewise, diagnostic services obtained outside of a public hospital are not eligible for OHIP reimbursement.
- Long-Term Care: This includes residential services or nursing homes.
- Assistive Devices: Assistive devices such as prosthetics are not covered by OHIP.
To cover these uninsured services, it’s highly recommended to buy private health insurance before leaving Ontario.
What if I’m Going to be Outside Ontario for a While?
If you’re planning to visit, work, or study in another Canadian province or territory for more than 7 months in a 12-month period, call ServiceOntario to confirm your OHIP coverage before leaving. There may be specific steps you need to take to make sure your coverage remains active.
OHIP Coverage Outside of Canada
Traveling outside Canada brings a different set of challenges regarding health coverage. OHIP provides limited coverage when you’re abroad, and it’s crucial to understand these limitations to avoid unexpected expenses.
OHIP covers emergency medical services obtained outside Canada, but only up to specific limits. For physician services, OHIP reimburses up to $400 per day for services that require the skills of a specialist, and up to $200 per day for other services. Hospital services are covered up to $400 per day for higher levels of care (e.g., intensive care) and up to $200 per day for lower levels of care.
If you require medical services that are not emergencies, OHIP’s coverage is minimal. Generally, only treatments pre-approved by OHIP are covered, and even then, reimbursement rates are much lower than the actual costs incurred.
OHIP does not cover prescription medications purchased outside Canada. Furthermore, medical evacuation (e.g., air ambulance services) is not covered by OHIP, which can be an expensive necessity if you experience a severe medical emergency abroad.
Given the limited out-of-country coverage provided by OHIP, purchasing supplementary travel health insurance is highly recommended.
Does OHIP Expire When You Leave the Country?
You can be outside of Canada for up to 212 days (7 months) within a 12-month period and still retain your OHIP coverage.
If you plan to be away for more than 212 days, you can apply for continuous OHIP eligibility to maintain your benefits. OHIP may extend coverage for up to 2 years if your extended absence is due to studying, working, vacationing, or missionary work.
How Do I Extend My OHIP Coverage?
If you plan to be outside Canada for more than 7 months within any 12-month period, you can maintain your OHIP coverage for up to 2 years by meeting the following criteria:
- Valid Health Card: Your OHIP card must be valid and up-to-date.
- Primary Residence: Ontario must remain your primary home.
- Residency Requirements: You must have been physically present in Ontario for at least 153 days in each of the two 12-month periods immediately before your departure.
Before leaving, visit your nearest ServiceOntario centre with proof of residency (e.g., a mortgage, lease agreement, property tax bill, or valid driver’s license) and your health card so that you can get your coverage extended while you are away.
What Happens if My OHIP Expires?
If your OHIP expires, you will no longer be covered by the provincial health insurance plan, and therefore you can’t expect to get reimbursed by the province for any medical costs. You would need to have private insurance to cover any health-related claims.
If you choose to move back to Ontario, you will need to wait 3 months before you can activate your OHIP coverage once again. Once the 3-month waiting period has passed, you can apply for OHIP coverage in person at a ServiceOntario centre.
Steps to Take Before Traveling Outside of Ontario
To ensure you’re adequately covered while traveling outside Ontario, follow these steps:
- Check Your OHIP Coverage: Review the specifics of your OHIP coverage for out-of-province and out-of-country travel. Visit the official OHIP website or contact ServiceOntario for detailed information.
- Purchase Travel Insurance: Invest in a comprehensive travel insurance policy that covers medical expenses, emergencies, and other travel-related issues. Compare different plans to find one that suits your needs and budget.
- Carry Your OHIP Card: Always carry your OHIP card with you when traveling within Canada. It helps facilitate direct billing and ensures you receive the coverage you’re entitled to.
- Understand Your Insurance Policy: Read the terms and conditions of your travel insurance policy thoroughly. Be aware of the coverage limits, exclusions, and the process for making claims.
- Keep Emergency Contacts Handy: Have a list of emergency contacts, including your travel insurance provider’s emergency hotline, local healthcare providers, and the nearest Canadian embassy or consulate.
The Bottom Line
While OHIP offers substantial coverage within Ontario and across Canada, its out-of-country coverage is limited. Understanding these limitations and taking proactive steps, such as purchasing travel insurance, can protect you from significant medical expenses when traveling. Being prepared ensures that your travels are enjoyable and stress-free, no matter where the road takes you.
Heading out of province for a while? Learn more about Canada car transport service or our car transport service for snowbirds.