OHIP: What’s covered when you’re out of Ontario

OHIP: What’s covered when you’re out of OntarioIn Ontario, we are lucky to have OHIP coverage, so that when we become sick or have an accident, we don’t think twice about visiting our doctor or going to the hospital in the event of an emergency.

However, once we leave the province, our access to medical coverage becomes less easily available – and more expensive.

While OHIP does offer limited coverage when we’re travelling out of province, it will only help to pay a limited amount toward costs incurred from medical treatment out of country, for things such as physician services and treatments at hospitals or other healthcare facilities.

Emergency out-of-country health services that are rendered to an insured person may also be covered, provided the following criteria are met, as set out by the Ministry of Health and Long-Term Care:

  • the treatment must be medically necessary;
  • 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, arose outside of Canada and requires immediate treatment.

It is important to note that if the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment will be made by OHIP.

What OHIP will pay is extremely limited and likely not enough to cover the full cost of the medical services or treatments. For example, OHIP will only play $50 CDN for outpatient emergency room services, $200 CDN per day for inpatient services and $400 CDN per day for hospital services that are rendered in an operating room, coronary care unit, intensive care unit or neonatal or paediatric special care unit.

In order to ensure you’re adequately covered while out of province, the Ontario government strongly urges residents to purchase travel insurance prior to travelling outside the province.  Many employee benefits plans include a travel insurance option – saving you the time and money of having to purchase it elsewhere.

By investing in travel insurance through your benefit program, you can ensure you’ll be sufficiently covered for costs and services that do not fall under OHIP’s out-of-province coverage, such as emergency medical and dental expenses, vision and hearing care care, hospital stays, ambulance travel and family transportation.

For complete details on OHIP coverage both in and out of Ontario, visit http://www.health.gov.on.ca.