Area of Law: Health Law
Answer # 696
Out of Province health care coverageRegion: Ontario Answer # 696
Canada maintains a universal health care system that provides health care services paid for by money collected from taxes. In Ontario, the government administers the Ontario Health Insurance Plan, called OHIP, which generally pays for health care services received by Ontario residents with a valid health card.
Coverage for “out of province, but within Canada” health care
1. What ‘out of province’ health care services are provided by OHIP?
Even if an Ontario resident receives health services in another province in Canada, they will normally be insured. According to the Ontario Ministry of Health and Long-Term Care, insured medical services are covered by OHIP for residents with a valid Ontario health card, while outside Ontario but within Canada, under two situations:
- When unexpected, emergency medical care is required while the insured Ontario resident is outside of Ontario but within Canada, and
- When planned, non-emergency medical care is required outside Ontario but within Canada. Such non-emergency medical services must be requested or recommended by either a licensed or practicing Ontario physician or a licensed and practicing physician who will be providing the services in the other province or territory. It is important to note that certain insured services must be approved prior to the health services being provided.
For more information about which services require prior approval, and how to obtain it, visit health.gov.on.ca.
2. Process for obtaining health care payments from OHIP for ‘out of province’ health care
There are two ways that ‘out of province’ health care treatment can be paid by OHIP. First, most physicians in other provinces, excluding Quebec, have the ability to bill OHIP directly if you present a valid Ontario health card when you receive treatment.
Second, if the physician who is treating you will not bill OHIP directly, after you pay for the service, you can apply for reimbursement from OHIP. If you are required to pay for services up front, you should first contact the Ontario Ministry of Health and Long-Term Care to confirm that the treatment will be covered by OHIP when you apply for reimbursement.
Out of Canada coverage
Anyone travelling outside Canada is usually covered for only a set fee for emergency health services. Emergency services include acute, unexpected conditions, illnesses, diseases, or injuries that require immediate treatment. Therefore, if travelling outside Canada, it is important to obtain additional private health insurance.
To receive reimbursement application forms, or for additional information, visit the Ontario Ministry of Health and Long-Term Care website.
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