Canadian Residents
If you have a valid Ontario health card you are entitled to certain benefits when outside Canada; however, since coverage for out-of-country health care services is limited, you should purchase supplementary insurance.

What does OHIP cover?
For people travelling outside Canada, OHIP covers only emergency health services. If you travel out-of-country for elective medical services that are available in Ontario and/or can be planned ahead of time, you are not covered.

Emergency health services are those given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment.

As of September 1, 1995, if you are injured or become ill while travelling outside Canada, OHIP will pay for emergency health services as follows :

• If you receive emergency care from a physician or other eligible health care provider, OHIP will pay only as much as that service would have cost in Ontario.
• Emergency inpatient hospital services eligible for OHIP coverage will be paid up to a maximum of $400 (Canadian) per day or the amount billed whichever is less :
  • The amount actually billed to a maximum of $400 per day for complex hospital care, that is rendered in a coronary care unit, an intensive care unit, a neonatal or paediatric special care unit or an operating room of an eligible hospital or health facility
  • Up to $200 for less intensive medical care
• Emergency outpatient services, with the exception of dialysis, will be paid to a maximum of $50 (Canadian) for all outpatient services provided on any one-day. Out-of-country dialysis treatment will be paid at a rate of $210 (Canadian) per treatment.

OHIP will cover services only when they are provided in hospitals or appropriately licensed health facilities.

• · For out-of-country inpatient services the health care facilities must routinely perform both complex medical and complex surgical procedures. For outpatient services, they must routinely perform either complex medical or complex surgical services.

OHIP will continue to cover necessary care for travelers with chronic conditions at the rates described above.

Why get private insurance?

• Many health services outside Canada cost much more than the ministry pays. You are responsible for any difference in cost.
• Some health services are not covered by the ministry. You will have to pay the full costs for them.
• An accident can happen to anyone, even during a very short business or recreational trip. Extra insurance must be purchased before you leave Ontario. Ask an insurance broker or insurance company for further explanation.

Reimbursement for Emergency Care Outside Canada
If you have purchased supplementary insurance, check with your insurance carrier about how you should submit your bills. Otherwise, send your itemized bill to your nearest OHIP office within 12 months of receiving treatment. With the bill, send :

• details of your treatments
• your original receipt for payment
• your name and current Ontario address
• your health number

To avoid delays, do not hold your bills and receipts until you return to Ontario. Mail them to your insurance carrier or the ministry as soon as you receive them

Payment for Out-of-Country Health Services with Prior Approval
OHIP will pay in full for health services outside Canada if :

• the patient gets written authorization from the Ministry of Health and Long-Term Care before the treatment is given; and
• the treatment is generally accepted in Ontario; and
• the treatment or an equivalent is not performed in Ontario; or
• the treatment is performed in Ontario but it is necessary that the person travel outside Canada to avoid a delay that would result in death or medically significant irreversible tissue damage.

In order to obtain consideration for full funding of treatment outside Canada your Ontario physician must apply to the ministry for prior approval while you are in Ontario, before you receive out-of-country treatment.

Travelling Inside Canada
Most of your Ontario health coverage benefits can be used across Canada. The province or territory you are visiting will usually bill the Ministry of Health and Long-Term Care directly for services.

If you have to pay for health care you receive in another part of Canada, such as podiatrists, or doctor's services in Quebec, you can apply for repayment from the ministry.

Out-of-Province or Out-of-Country Health Services Claims Timeline
The Ministry of Health and Long-Term Care has recently changed a regulation to establish a 12-month time limit for people who are submitting claims to OHIP for health services received outside Ontario or out-of-country.

This 12-month time limit is currently in use. The government of Ontario has amended Ontario Regulation 552 of the Health Insurance Act to reflect the current practice.

The ministry extended the deadline period, recognizing the additional time it can take for Ontario residents to obtain the necessary documents from out-of-province or out-of-country providers.

This information may change, and is of a general nature only. It is subject to the provisions of the Health Insurance Act.

For further information, refer to Shorter Absences from Ontario and Longer Absences from Ontario.

FOR MORE INFORMATION :
Call the ministry INFOline at 1-800-268-1154
Toll-free in Ontario only)
In Toronto, call 416-314-5518
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm

Visit HealthyOntario.com for information on a wide variety of consumer health topics.