Does Ontario Health Insurance Cover Health Care Outside of Ontario

If you're planning a trip outside of Ontario, you might be wondering if your health insurance will cover you. Ontario's health insurance, also known as OHIP, generally covers medical services received within the province.

However, if you're traveling outside of Ontario, your coverage may be limited. According to the Ontario government, OHIP does not cover medical services received outside of Canada.

But, if you're traveling to another province or territory in Canada, you may still be covered for medical services through a reciprocal agreement between provinces. This means that if you're a resident of Ontario, you may be able to receive medical services in another province without having to pay out-of-pocket.

If you're planning to travel or move to another Canadian province or territory, you'll want to know about Ontario Health Insurance coverage. You'll be covered for some services in other provinces, including physician services and public hospital services.

To be eligible, you'll need to show your valid Ontario health card. Any service or treatment you receive must be medically necessary for it to be covered by OHIP.

If you're going to be in another province for more than 7 out of 12 months, you'll need to confirm your coverage before you leave. This is a good idea to avoid any unexpected medical bills.

Some jobs require frequent travel, and if you're a mobile worker, your OHIP coverage will continue. To qualify, you'll need to travel for work for more than 212 days in a 12-month period and make Ontario your primary home.

If you're studying full-time in another province, you'll need to have lived in Ontario for at least 5 months in the 12 months before leaving and bring proof of enrollment to the nearest ServiceOntario centre.

Here's a quick summary of what's covered when you're in other provinces:

Remember to confirm your coverage before leaving Ontario if you'll be away for more than 7 months, and consider your job requirements and study plans to ensure you're eligible for OHIP coverage.

You can keep your OHIP coverage if you're away from Ontario for more than seven months, but you'll need to confirm your coverage before you leave by calling ServiceOntario.

If you're a mobile worker, your OHIP coverage will continue if you qualify as a mobile worker, which means you must travel frequently for more than 212 days in any 12-month period for work and make Ontario your primary home.

To keep your OHIP coverage while studying full-time in another province or territory, you must have lived in Ontario for at least five months in the 12-month period immediately before leaving and be enrolled in full-time academic studies elsewhere in Canada.

To qualify as a mobile worker, you'll need to bring proof to the nearest ServiceOntario centre that includes:

If you're planning to be away from Ontario for more than 7 months, you'll need to confirm your OHIP coverage before you leave. This is true whether you're visiting, working, or studying in another Canadian province or territory.

Call ServiceOntario to determine what you may need to do to maintain your coverage. They'll guide you through the process and help you understand what's required.

If you're away for more than 7 months, you'll need to confirm your coverage. This is a crucial step to ensure you're covered for any medical expenses that may arise while you're away.

Here are the specific requirements for maintaining your OHIP coverage while away from Ontario for more than 7 months:

If you're a full-time student, you're likely wondering about your healthcare coverage. To keep your OHIP coverage while studying full-time in another province or territory in Canada, you must have lived in Ontario for at least five months in the 12-month period immediately before leaving.

You'll need to bring proof of residency to the nearest ServiceOntario centre. This can be in the form of a utility bill or other document that shows your address.

To qualify for OHIP coverage, you must also be enrolled in full-time academic studies elsewhere in Canada. This means you'll need to provide a letter from your school on official letterhead.

Here's a quick summary of the requirements:

By meeting these conditions, you can continue to receive OHIP coverage while pursuing your studies in another province or territory.

If you receive medically needed services or treatment in another Canadian province or territory without showing your valid Ontario health card, you may be charged. This can also happen if a doctor charges you even if you show your health card, as they have the right to do so.

You can submit a claim to OHIP within 12 months of the date you received the service or treatment to get your money back. This is a good thing to keep in mind if you're planning a trip out of province.

To submit a claim, fill out the Out of Province/Country Claims Submission form, attach an original statement from the person who provided treatment, and include proof of payment. Make sure to make copies of the completed form, statement, and proof of payment for yourself.

To get pre-approval for planned procedures, you'll need to check the Schedule of Benefits for Physician Services, which outlines which services require prior approval. Some examples of services that require prior approval include a breast reduction or panniculectomy.

Your healthcare provider can help you determine if prior approval is needed and guide you through the process. You can also speak with your Ontario physician or out-of-province physician to submit a Request for Prior Approval Application for Full Payment of Insured Out-of-Province Health Services form.

If you're charged for medically needed services or treatment in another Canadian province or territory, you can get reimbursed through OHIP. You'll need to submit a claim within 12 months of the date you received the service or treatment.

To be eligible for reimbursement, you must show your valid Ontario health card, but even with a health card, you may still be charged by a doctor. This is because doctors have the right to charge patients even if they show their health card.

You can submit a claim to OHIP by filling out the Out of Province/Country Claims Submission form. This form requires an original statement from the person who provided treatment, which must include proof of payment.

You'll also need to make copies of the completed form, statement, and proof of payment for yourself. Then, mail your claim to the OHIP Claims Office at 347 Preston Street, 4 Floor, Ottawa, ON K1S 3J4.

Here are the steps to submit an OHIP claim for reimbursement:

If you're traveling to another Canadian province or territory, you're still covered for some essential services.

You can use your valid Ontario health card to access physician services, such as a visit to a walk-in clinic.

Services provided in a public hospital, like emergency, diagnostic, or laboratory services, are also covered.

Any service or treatment you receive in another province must be medically necessary to be covered by OHIP.

Here's a quick rundown of what's covered when you're out of province:

Remember, only medically necessary services are covered by OHIP when you're out of province.

International coverage for Ontario residents is limited when traveling outside of Canada. As of October 1st, 2019, OHIP no longer covers medical expenses for travellers outside of Canada, except for emergency treatment.

For emergency treatment, OHIP will only reimburse up to $50 per day, and ambulance services are not covered if you're outside of the country. It's essential to have additional private medical insurance to avoid incurring medical bills in case of an accident or injury.

To get prior approval for non-emergency treatment, your physician must submit a Prior Approval Application to the Ministry of Health and Long-Term Care. The application must meet specific criteria, which includes being performed at a hospital or licensed health facility, not being experimental, and being generally accepted in Ontario as appropriate for a person in the same medical circumstances as the insured person.

Here's a summary of the prior approval application requirements:

If you're going to visit, work or study in another Canadian province or territory for more than 7 out of 12 months, you need to confirm your coverage before you leave.

You can call ServiceOntario to determine what you may need to do.

It's essential to confirm your coverage to avoid any disruptions in your medical care.

If you're an Ontario resident traveling abroad, you're not covered by OHIP for non-emergency treatment, and even emergency treatment is only reimbursed up to $50 per day.

To get coverage for non-emergency treatment, your physician must submit a Prior Approval Application to the Ministry for consideration. This application requires proof that the services and treatment being requested are medically necessary and meet specific criteria.

For emergency treatment outside of Canada, OHIP will only reimburse up to $50 per day, and ambulance services are not covered. This is why it's essential to have additional private medical insurance when traveling abroad.

Here are the specific criteria that must be met for non-emergency treatment to be covered by OHIP outside of Canada:

It's worth noting that as of October 1st, 2019, OHIP no longer covers medical inpatient services for up to $400 a day and outpatient emergency services for up to $50 a day for travelers outside of Canada.