OHIP Out-of-Country Coverage Is Winding Down and What You Should Know

Author(s): Leonard H. Kunka

December 11, 2019

The Ontario Government will start winding down the OHIP Out-of-Country Travellers Program as of January 2020 and Ontario residents need to know what that means for them.

The program currently provides limited coverage for emergency health care expenses incurred when an Ontario resident is travelling outside of Canada.

Coinciding with the removal of the OHIP Out-of-Country Travellers Program, the government has created a new agency — the Ontario Renal Network — which will continue to pay $210 per treatment for patients requiring dialysis while travelling outside of Canada. Even this coverage is unlikely to cover the actual cost of dialysis, which can range from $300-$750 per treatment in the United States.

Many people who travel outside of the country are under the mistaken belief that medical expenses incurred while travelling outside of Canada will be covered by OHIP. The reality, however, is that OHIP only covers approximately 5% of the typical out-of-country emergency medical costs. For example, the OHIP Out-of-Country Travellers Program currently allows for up to $400 per day for emergency in-patient services for an Ontario resident who is confined to hospital in the United States. The actual cost per day for a hospital stay in most of the United States far exceeds $400 per day. Similarly, the amount covered by OHIP for surgeries or other medical treatments provided outside of Canada is often a fraction of the actual cost.

With these proposed changes on the horizon, it is now more important than ever that Ontarians who plan to travel outside of the country purchase private out-of-country medical insurance to protect themselves against these potentially staggering medical costs.

The only good news about these proposed changes is that the removal of OHIP’s contribution to out-of-country medical costs should result in a simplification of the process for recovering medical costs incurred outside Canada from your privately purchased travel insurance carrier. Under the current system, recovering these costs from the private travel insurance carrier is often delayed while the private travel insurance company waits to see what amount will be covered by the OHIP Out-of-Country Travellers Program.

Those Ontarians who are injured in car accidents outside of Canada should also be reminded that if you have an Ontario car insurance policy, the standard accident benefits under your own auto insurance policy provides coverage for medical expenses incurred arising out of a motor vehicle accident which occurs in the United States or elsewhere in North America. However, because the accident benefits coverage is also limited, this is not a substitute for having privately purchased out-of-country travel insurance.

Leonard Kunka is a partner and personal injury lawyer at Thomson Rogers whose practice is focused on advocating for those who have been seriously injured in motor vehicle accidents. Leonard can be reached at 416-868-3185 or by EMAIL.

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