When you travel outside of Canada OHIP will NOT pay the same medical expenses that are covered in Ontario.
If you are a resident of Ontario and you are insured under OHIP, you are entitled to very limited funding for a limited range of medical services when you are traveling outside of Canada. OHIP will pay very limited amounts for physician services and hospital/health facility services, and only if certain conditions are satisfied.
For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada and ensure that the supplementary insurance you have purchased provides adequate coverage.
OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an "emergency" there are a number of criteria that must be satisfied. These criteria are set by regulation and include the conditions listed below that must be met:
- the treatment must be medically necessary, and
- the treatment must be performed at a licensed hospital or licensed health facility, and
- the treatment must be rendered in relation to an illness, disease, condition or injury that: is acute and unexpected, and arose outside of Canada, and requires immediate treatment
These provisions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario if they incur an unexpected illness, disease, condition or injury while they are outside of Canada. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.
The following is NOT covered by OHIP:
- treatment that is medically unnecessary
- health services that are rendered at a facility that is not a licensed hospital or licensed health facility
- treatment that is generally accepted by the medical profession in Ontario, as being experimental, or for research or for part of a study
- treatment rendered for an illness, disease condition or injury that arose inside Canada
- ambulance services or transportation costs
- other services specifically set out in the regulations as uninsured or otherwise not listed as insured
How much will OHIP pay?
- The amount that OHIP pays is set by regulation. The amount paid for out-of-country health services is very limited and usually will not be sufficient to cover the full cost of the services rendered. OHIP covers only very limited amounts for hospital, health facility and physician services.
- For physician services, OHIP will pay the actual cost billed by the out-of-country physician(s) or the cost of the same physician service(s) in Ontario, whichever is less. Physician services in Ontario are usually rendered at a significantly lower cost than those billed at out-of-country health facilities. Please note that out-of-country health facilities and physicians usually bill separately.
- For outpatient emergency room services, OHIP will pay $50 Canadian (CDN) per day.
- For inpatient services, OHIP will pay $200 CDN per day. If the services are inpatient services rendered in an operating room, coronary care unit, intensive care unit, neonatal or pediatric special care unit, then OHIP will pay at the higher rate of $400 CDN per day for hospital services.
- For outpatient dialysis services, OHIP will pay $210 CDN per day.
The "per day" rates listed above cover all hospital inpatient services including, but not limited to, accommodation, meals, prescription drugs, surgically implanted devices and nursing services.
OHIP does not pay for ambulance services, transportation costs, or out-of-hospital food/accommodation/drugs or prescriptions
It is strongly recommended to buy additional travel insurance, whether you are absent from Canada for a few minutes or for an extended time. OHIP does not insure or pay for all out-of-country medical services. Also, the amount of funding provided by OHIP will not usually cover the full cost of any health services that you do obtain outside of Canada. You should therefore, obtain supplementary health insurance from a private insurance company to provide you with additional coverage during your absence. It is also recommended that you understand the terms and conditions of the additional insurance coverage you have purchased and the implications of any pre-existing health conditions on your insurance coverage. To obtain private insurance contact a private insurance company of your choice.
For reservation and information please contact Altair Travel: