Recently, I got a call from one of my long-term clients. He and his family are planning a road trip from Toronto to Vancouver this summer. They have been dreaming about it for years. Although all of them are covered by OHIP (Ontario Health Insurance Plan), he’d like to know if they still need to buy medical insurance as Canadians travelling inside Canada. My answer was yes.
His question was a reason for this article because many Ontarians truly believe that there is no need to purchase Out-of-Province travellers medical coverage. Let’s take a closer look.
OHIP Coverage across Canada
Usually, insured Ontario residents who travel temporarily outside Ontario but within Canada continue to receive OHIP coverage, however with some restrictions. (Just to remind you: to be continuously eligible for OHIP in Ontario and inside Canada, a person must be physically present in Ontario for 153 days in any given 12-month period.)
Medical services covered by OHIP include illness, disease or injury that arises outside of Ontario but within Canada and requires immediate treatment. Generally, these services are of two types – physician’s services and public hospital services.
Before any of these services being rendered, an insured Ontario resident must show his/her valid OHIP card. If he/she does not present the health card, the hospital or physician can bill the Ontario resident directly (not the Ministry of Health and Long-Term Care of Ontario)
Services provided by a physician
Physicians in all Canadian provinces or territories have the option of billing the Ministry or the Ontario resident for the insured services being provided. So, to ask the physician whether the physician fees will be billed directly to Ontario Ministry is a good idea.
If the patient is billed for the health services provided, they may get reimbursement by submitting all original documents to the Ministry; copies of all receipts must be kept for future reference. A claim for reimbursement should be submitted to a processing office for out-of-province claims in Ottawa within 12 months of the services being rendered.
The Ministry of Health and Long-Term Care claims processing office for out-of-province claims is:
- Ministry of Health and Long-Term Care
- Claims Processing
- 75 Albert Street
- 7th floor
- Ottawa ON K1P 5Y9
To make a claim to OHIP, submit a fully itemized bill that includes all the following:
- An original, detailed statement itemizing the fee for service
- Proof of payment
- Your name and current address in Ontario
- Your Ontario health card number including the version code if applicable
- A completed “Out of Province/Country Claims Submission” form (0951-84).
The insured physician services will be paid the same rates paid to Ontario physicians, or at the amount billed, whichever is less.
Services provided at a public hospital
When insured services are provided in a publicly funded hospital that participates in reciprocal billing agreements there are no charges to the patient for the hospital costs.
What OHIP does not cover
- Ambulance services provided to Ontario residents outside of Ontario, but within Canada are not covered by OHIP.
- OHIP does not cover payments to private health clinics or hospitals.
- OHIP does not pay for non-physician and non-hospital services.
- OHIP does not cover treatments that are medically unnecessary
Costs for any medical services received by an OHIP-covered Ontario resident in any private clinic in Canada are not insured. It is the responsibility of the patient to enquire from the hospital if they will accept his/her OHIP card before the services are rendered. Call toll-free – 1-888-359-8807 – to verify with the Ministry whether the hospital is publicly funded or a private facility.
If you plan to travel outside of Ontario, but within Canada, and would like to obtain additional medical insurance, I will make sure that you fully understand what your policy covers.
By Olga Ryjkova, Insurance Broker
