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Know What OHIP Does and Doesn’t Cover When You Are Out of Canada

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Covered by OHIP? You still need travel insurance. Here is what you need to know about OHIP Out of Country (OOC) Health Service Coverage to protect yourself and your wallet.

In 2020, Ontario’s Ministry of Health reinstated OHIP coverage for out-of-country emergency hospital, health facility and doctor services.

Even so, the Ontario government recommends that you buy travel health insurance coverage in case you need emergency health services while you are out of the country.

You should not rely only on OHIP coverage to take care of the cost of medical care if you have an accident or illness while you are travelling. Here’s why.

You have limited out-of-country health service coverage with OHIP

OHIP will only cover very limited costs if you receive emergency health services while you’re travelling outside Canada for

  • medical assessments or emergency surgery services
  • outpatient services like x-rays or CT scans
  • inpatient services like room-and-board hospital stays and nursing services.

If you incur expenses, you must pay the provider yourself, up front. The out-of-country program only reimburses you for between $200 and $400 per day for emergency inpatient services (meaning an ICU or operational surgery) and up to $50 per day for emergency outpatient services.

When you are out of the country, OHIP does not cover you for

  • ambulance services (by land, water or air) needed to transport you if you are sick or injured to and from places of treatment
  • prescriptions for things like painkillers and antibiotics
  • the full cost of doctor services, outpatient services or inpatient services.

You need travel insurance

If you have a medical emergency when you are out of the country visiting family, on business or on vacation, you will be faced with paying the cost of care — regardless of the severity of your situation.

Even one simple outpatient visit to a U.S. emergency room may cost thousands of dollars. Here are some examples that may surprise you.

Needing to pay out of pocket for hospital and doctors’ charges in other countries (not only the U.S.) can be a dire result of becoming ill or suffering an accident while away from home. That’s why travelling uninsured is a risk you don’t want to take.

What kind of travel insurance do you need?

Ontarians travelling abroad are always encouraged to purchase the appropriate travel insurance coverage — but what does that mean? The first thing to understand is that all coverage is not equal.

Even if you have some travel health insurance through your workplace plan or credit cards, the first step is to take the time to review and understand any requirements, conditions and exclusions. Does it cover you for the duration of your trip (especially if you plan on being away for over a week)? Does it cover emergency medical needs, or only trip cancellation and baggage loss?

Get the details! Smart travellers ensure that their travel insurance covers

  • hospitalization or doctor visits while abroad
  • ambulance service, including land, water or air transportation to and from places of treatment for an illness or injury
  • medical evacuation to a nearby facility that can provide appropriate care or  return you to Canada, as well as the cost of a medical escort
  • their age and health status
  • preparation of your remains and repatriation to Canada in case of death.

How do you get the travel insurance you need?

If your doctor agrees that you can travel, SBIS offers a wide range of travel insurance options that are suitable and varied enough to cover you. And there are even options that do not require you to provide detailed health information.

We can help you put in place coverage that fits both your budget and your needs based on your age, medical history, the medications you take, your travel destination, your lifestyle and how frequently you travel.

Be prepared: insure every out-of-country trip

Travel insurance can help make sure the financial elements of a vacation emergency are under control, so you can focus on family, friends, fun, and the experience.

At SBIS, we cover Ontarians (and all Canadian travellers) with travel medical insurance and trip interruption or cancellation and loss of baggage coverage. To put your travel insurance plan in place, start by going online, get in touch with us by email or give us a call at 1-800-667-0429 Monday to Friday, 8:45 a.m. to 4:45 p.m. ET. Contact us today to learn more about your travel insurance coverage options. We’re ready to help.

10 Responses

  1. I’m going to the U.S.A . for rotator cuff surgery. The wait time here in Ontario is far too long
    considering the tremendous pain I am suffering. Will OHIP cover any of my expenses including an MRI?

    1. Thank you for your question. This type of procedure is not generally covered by OHIP however there are exceptions to this rule you may want to look into.

      https://www.health.gov.on.ca/en/public/programs/ohip/outofcountry/prior_approval.aspx

      An application must be completed by the referring physician and submitted for pre-approval.

      OOC = OUT OF COUNTRY

      Full payment of medically necessary hospital/medical services will be authorized only when the proposed OOC treatment or
      procedure is:
      • performed at a hospital or licensed health facility; and
      • not experimental or for research or for a survey; and
      • generally accepted by the medical profession in Ontario as appropriate for a person in the same medical circumstances
      • as the insured person; and
      • either not performed in Ontario by an identical or equivalent service; or
      • performed in Ontario but the insured person must receive the services outside Canada to avoid a delay that would
      result in death or medically significant irreversible tissue damage.

  2. I’m travelling to Costa Rica. Leaving Canada in November and staying possibly all winter. Please advise a health policy.

        1. Thank you for your comment/question Please give us a call at 1-800-667-0429 to speak about your specific situation and what plans we can put in place while you are away to keep you insured.

    1. Our travel insurance provides up to $5 Million for Canadian residents travelling abroad to places like Ireland for unforeseen emergency accidents and illnesses. Please give us a call at 1-800-667-0429 for more information regarding your trip options. Thank you

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