OHIP coverage for outside Canada travellers

“Why do I need travel insurance? I’m young and healthy. And if something happens OHIP will pay.”

Let’s see what OHIP covers. For Ontario residents travelling outside Canada, the Ministry of Health and Long-Term Care of Ontario pays a set rate for emergency medical services – the services that are given in connection with an acute, unexpected condition, illness, disease or injury that arises outside Canada and requires immediate treatment. Ambulance services are not covered.

To qualify as an “emergency medical services” there are a number of criteria that must be met. These provisions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario if they incur an unexpected illness, disease, condition or injury while they are outside of Canada. Generally, these services cost much more than OHIP may pay. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.

What is not covered by OHIP while travelling outside Canada?

  • ambulance services or transportation costs
  • treatment that is medically unnecessary
  • health services that are rendered at a facility that is not a licensed hospital or licensed health facility
  • treatment that is generally accepted by the medical profession in Ontario, as being experimental, or for research or for part of a study
  • treatment rendered for an illness, disease condition or injury that arose inside Canada

How much will OHIP pay?

  • For physician services, OHIP will pay the actual cost billed by the out-of-country physician or the cost of the same physician service in Ontario, whichever is less. Also, you have to keep in mind that out-of-country hospital or other health facility and physicians are usually billed separately.
  • For outpatient emergency room services, OHIP will pay $50 Canadian (CDN) per day.
  • For inpatient services, OHIP will pay $200 CDN per day. If the services are inpatient services rendered in an operating room, coronary care unit, intensive care unit, neonatal or paediatric special care unit, then OHIP will pay at the higher rate of $400 CDN per day for hospital services.
  • For outpatient dialysis services, OHIP will pay $210 CDN per day.

So, if you don’t believe in travel insurance, then you should. Here are only a few examples from my 15-year experience as travel insurance broker.

Dengue Fever

“I never heard about this debilitating viral disease of the tropics, transmitted by mosquitoes, until my trip to Bolivia. All of a sudden I got this massive headache and acute pains in the joints. My body began to shiver uncontrollably and my temperature rose to 41 Celsius. At the local hospital they easily identified that I had Dengue Fever. My travel insurance paid for the hospital treatments and flights home.”

Food Poising

“I came down with severe food poising after an evening at the beach party with the friends in Dominican Republic. I spent four nights at a hospital with IV antibiotics.”

Twisted Ankle

“While walking along cobblestoned streets in Toledo I twisted my ankle so hard that could not make a step. I was transported to a hospital, had an X-ray and other treatments. I also had to buy a pair of crutches to get back home.”

Family Emergency

“In the middle of my trip to New Zealand I got a call from my mother to tell me that my grandmother had collapsed from a stroke and doctors predicted she only had two weeks to live. My travel insurance paid for the trip interruption and flights home.”

Fall in a bathtub

“Being on my vacation in Florida, I slipped and fell in the bathtub. At first the pain was not that bad, but next day I couldn’t move my back. I checked into the hospital, had x-rays taken, and underwent physiotherapy.”

Remember, you are entitled to very limited funding for a certain range of medical services when you are travelling outside of Canada. For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada and ensure that the supplementary insurance you have purchased provides adequate coverage.

I’ll be happy to help you with all your travel insurance needs, just contact me:

Cell: 416-822-2698

Email: olga.ryjkova@gmail.com

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