As of January 1, 2020, the Ontario Health Insurance Plan (OHIP) no longer covers any portion of out-of-country medical expenses.
Details of the announcement can be found on the Ontario Ministry of Health and Long-Term Care’s website.
What does this mean to you?
Whether it’s for work or leisure—and regardless of your international destination—it’s more important than ever to make sure you’re protected from unexpected medical emergencies when travelling outside of Canada.
Previously, OHIP covered out-of-country inpatient services to a maximum of $400 per day for higher-level care like intensive care, and up to $50 per day for emergency outpatient care and physician services.
This coverage is no longer in place.
Insured Ontario residents will continue to be covered for physician and hospital services when visiting or moving to another Canadian province or territory. Ontario renal dialysis patients will receive coverage for out-of-country dialysis services under a new plan launched concurrently with the cuts.
Make sure you have appropriate travel insurance coverage.
The Ministry of Health and Long-Term Care is advising Ontarians travelling abroad to purchase appropriate travel insurance coverage in the event emergency health and doctor services are needed out-of-country.
You’ll need to ensure you have travel insurance coverage and (just as importantly), that you fully understand what the policy covers—and what it doesn’t.
Will emergency out of Canada travel healthcare coverage under my group benefits plan be enough?
Travel coverage provided under your group policy is often enough under most circumstances.
If you’re enrolled under the extended health care portion of a group benefits program, your employee booklet will explain the details of this coverage.
- If you’ve waived coverage under your employer’s group plan—for example, because you have spousal coverage under another plan—then you should turn to your spouse’s plan for details about emergency out-of-country travel
Contact your group benefits provider’s call centre to learn about your coverage, if there are questions regarding your:
- Specific medical issues
- Pre-existing conditions
- Planned activities
Your carrier’s call centre may also direct you to their 1-800 provider for more information.
Fully understand the level of coverage your plan offers before departing.
You may need to purchase additional travel insurance.
A group plan travel benefit is intended to cover general unforeseen emergency risks during regular travel excursions, such as cross border trips, sun resorts, cruises, and occasional business travel.
- It’s not blanket coverage, and it’s not intended for special risk circumstances, such as people working abroad for extended periods, or dangerous adventure trips in exotic locales
- There may also be considerations and exclusions for specific medical conditions
Your carrier or their emergency out-of-country insurance partner will be able to review any exclusions or pre-existing health conditions that apply to your circumstances.
You must be covered under OHIP to be eligible for group benefits travel emergency out-of-country coverage.
Even though OHIP no longer covers out-of-country emergency care, effective January 1, 2020, it is a prerequisite for group benefits travel emergency out-of-country coverage.
Unsubmitted out-of-country OHIP claims.
OHIP will reimburse eligible emergency out-of-country claims incurred up to and including December 31, 2019. The timeframe to submit eligible claims is 12 months from the date of service. Eligible claims can be submitted up to December 31, 2020.
Still have questions?
Contact your Cowan representative if you have questions about how OHIP’s change in coverage affects you—we’re here to help.