Snowbirds Next Flight Needs to Bridge OHIP Coverage Gap

OHIP Changes 2020

Lost in all of the daily news about the coronavirus is a policy tweak to Ontario’s public health insurance plan that applies to anyone travelling outside the province who requires health services.

Although it might not be front of mind for most people, given the current global pandemic, many Ontario residents will eventually emerge from the health lockdown looking to travel outside Canada this summer and beyond.

When they do start planning a trip, they might be surprised to learn their public health insurance plan (OHIP) no longer provides coverage outside of Ontario.

As of January 1, 2020,* OHIP will not cover medical expenses for out-of-country health services. The move by the Ontario government was announced in spring 2019 following a brief six-day consultation period.

What Does This New Policy Mean for Ontario Travellers?

Well, for starters, it means that anyone leaving the province without purchasing private travel health insurance will be on their own for any out-of-pocket expenses incurred for health services.

Under the previous set-up, OHIP’s Out-of-Country Travellers program would cover up to $400 a day for more advanced health services, and up to $50 a day for doctor and emergency outpatient services. These maximum amounts represent less than 5% of out-of-province medical expenses and the Ontario government argued this was insufficient coverage, given the limited maximum dollar amounts.

More to the point, the Ontario government said the administrative costs of running the out-of-country insurance program were not proportionate to the value of yearly claims—the program costs $2.8 million to administer $9 million worth of health claims each year.

Bear in mind the new policy does not affect travel between provinces within Canada: you will still have some OHIP coverage if you travel to other provinces or territories, just not abroad.

There is also a single exception to the new OHIP policy: coverage is still in place for those who need renal dialysis when they travel abroad. OHIP partnered with the Ontario Renal Network to provide coverage of up to $210 per treatment when travelling outside the country (this amount is exclusive to this health condition and any additional emergency expenses are at the traveller’s expense).

Not So Fast: Is OHIP’s New Approach Constitutional?

The new OHIP policy has its critics, drawing the ire of the Canadian Snowbird Association, an advocacy group representing Canadians who frequently spend their winters in sunny climes. The group promptly filed a lawsuit seeking judicial review of the policy, saying it contravenes the Canada Health Act (CHA).

They say the policy was implemented without adequate consultation and goes against the portability provisions of Canada’s national public health care system. Under the CHA, Canadian residents who are temporarily absent from their home province or territory or from Canada must continue to be covered for insured health services during their absence. If insured persons are temporarily absent in another province or territory, the portability “pillar” of the CHA requires that insured services be paid at the host province’s rate. If insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.

Before and After: OHIP Coverage While Travelling

Before January 2020 After January 2020
All provinces offered public health coverage for out-of-country travel Ontario is only province to not offer public health coverage for out-of-country travel
Provided up to $400 a day for advanced medical services No medical expenses are covered (except renal dialysis, which is covered at $210 per treatment)
Provided up to $50 a day for doctor and emergency outpatient services No coverage for doctor and emergency outpatient services
Private supplementary travel health insurance is recommended Private supplementary travel health insurance is essential
Inter-provincial travel: health insurance provided through OHIP Inter-provincial travel: health insurance is still covered by OHIP

Ontario is now the only province or territory in Canada that doesn’t offer any out-of-country health insurance, which some industry watchers say will pave the way for other provinces to do the same.

Ontario residents will now incur additional out-of-pocket costs for a medical emergency if they have not purchased supplemental health insurance, such as:

  • Ambulatory services
  • Repatriation to the province of residence
  • Prescription drugs
  • Emergency dental care services
  • Specialized services such as physiotherapy, chiropractic and osteopathy

The federal government was critical of the new measure, saying it will create hardship for Ontario residents, forcing them to purchase private health insurance with expensive premiums (the Snowbird Association estimates a 7.5% increase in travel insurance premium costs as a result of the new policy). However, it’s not clear that potential premium increases will be substantial, considering the out-of-country OHIP coverage was so limited to begin with.

We’d love to hear your take, so be sure to let us know in the comments section how you feel about the changes.

If nothing else, the absence of public coverage under OHIP will serve to make Ontario consumers much more aware of the terms and conditions of their travel insurance. According to a 2018 consumer survey by the Travel Health Insurance Association of Canada, 65% of travellers don’t understand what their provincial medical insurance covers when out of province.

Another issue in play is how private health insurance providers deal with travel-related claims in a world grappling with the coronavirus pandemic. The bottom line is that given the current world-wide travel restrictions in place, a health insurance claim related to the pandemic won’t be covered, as the coronavirus is now considered a known health risk.

With so much uncertainty in the area of health and travel during these unprecedented times, it is prudent to explore private health insurance options if you’re thinking about taking a trip outside Canada any time soon. Many Ontarians have such coverage through their workplace health insurance plans, and some purchase this through their credit card company.

Travel Insurance: What You Need to Know Before Your Next Trip

Here are some tips to keep in mind when you’re ready to purchase health insurance for your next trip abroad:

  • Be prepared: Have the particulars of your health status handy when you’re going to apply and know the specific details of your trip.
  • Stand up for your rights: Know the process and your rights when it comes to appealing a claim.
  • One size does not fit all: Seek coverage that fits your budget, your travel plans, the destinations you visit and your health conditions before you leave for your trip.
  • Details, details, details: If you have group travel insurance through your employer or a professional association, or coverage through your credit card provider, read the policy very closely to see what’s included and, most importantly, what’s not. Often, there are limitations that may not reflect your travel plans.
  • Beyond the sticker: Don’t simply compare the price of your travel health insurance quote; carefully review the coverage amounts, limitations and benefits, as well as the services included with each plan.
  • Make it personal: Ask yourself what sort of additional coverage you and your family might need to ensure you are well-protected. You can personalize your coverage to include benefits that cover you in case of:
    • Trip cancellation or interruption due to circumstances outside of your control
    • Baggage loss or theft
    • Accidental death or dismemberment

Of course, Mitchell & Whale is one of Canada’s leading insurance brokerages and it is our mission to find you affordable and inclusive plans to give you peace of mind when you travel out of the country.

Get in touch with us to assess your individual situation and we’ll shop your request through 40+ different insurance providers to arrive at the best quote.

Let us do the legwork for you before you book your next out-of-country trip!

*For out-of-country claims that would have fallen under the previous OHIP policy, you may be able to get some of your money back through OHIP if you paid for qualifying medical services that you received up to and including December 31, 2019. You must submit an OHIP claim within 12 months of receiving and paying for the medical services. Therefore, the last day that an emergency out-of-country health and/or doctor service claim can be submitted to OHIP for reimbursement will be December 31, 2020.



One Comment

  1. Avatar
    Rahul Sharma-Reply
    September 18, 2020 at 7:23 am

    My wife was 2 month pregnant when she had to fly outside of the country due to a family emergency and had to stay there till March. As she was about to come back the destination country went through a lockdown during pandemic, no flights possible. By the time rescue flights could be arranged she was advised by Doctors not to travel and she had to deliver our babies out of Canada.

    Now OHIP does not cover her and even my group insurance says she is eligible for their coverage only if she is covered by OHIP.

    I was double sure with OHIP and then the private insurance but it seems both are here to just screw us over. Its more of a planned technique that Insurance companies apply with help from Government.

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