A dream vacation can be interrupted by illness or accident. Take a look at what OHIP really covers, as well as your work insurance policy to make sure you have everything you need. (Photo: FinderCodes)
Two years ago a newly-married Canadian man travelled to Mexico with his wife, and one night they decided to set sail on a boat cruise.
Right before cast off, the man felt light headed. Thinking it was the result of spending a full day in the hot sun, they boarded the boat…
Hours into the cruise the man suffered a massive heart attack. Too far away from a hospital, officials called in for a helicopter to come and transfer him to a health care facility in the city. He spent one month in the hospital before stabilizing and being transferred to Toronto General Hospital, where he was put on the waiting list for a heart transplant.
Unfortunately this story is not unique. Canadian patients come to UHN having been transferred from hospitals all over the world. In most cases, people have enough health insurance to pay for the cost of medical care. In other cases, they aren't so fortunate and have to pay out of pocket for all the costs, which can accumulate to hundreds of thousands of dollars.
It's important to understand what your provincial health plan covers, as well as your work plan when travelling. It's also important to look into third party health insurance plans to make up for any of the gaps you might have in your current coverage.
What does Ontario Health and Insurance Plan (OHIP) cover while traveling within Canada?
For the most part, Ontarians traveling within Canada are covered for the cost of health care. For example, if you were from Ontario and needed medical attention in British Columbia – British Columbia's health ministry would bill Ontario's health ministry for its services.
It's important to remember however, that prescription drugs, home care services, ambulance services and long-term care services provided in other provinces and territories are not covered by OHIP.
This means that unless you have another insurance plan that takes care of the cost of these items, you will pay out of pocket.
What does OHIP cover while travelling outside Canada?
OHIP pays a set rate for emergency health services outside of Canada. Meaning if an Ontarian suffers from an acute, unexpected condition, illness, disease or injury outside Canada and requires immediate treatment - OHIP will pay.
OHIP, however, will only pay up to a certain amount. This becomes an issue in cases when emergency health services outside Canada cost much more than what OHIP will cover.
Because of this, The Ontario Ministry for Health and Long Term Care recommends Canadians purchase additional health insurance before travelling to cover extra health care costs.
What isn't covered by OHIP while traveling outside Canada?
- 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
- Ambulance services or transportation costs
- Other services specifically set out in the regulations as uninsured or otherwise not listed as insured.
For more information, visit Ontario Ministry of Health and Long Term Care
What is covered by your work health insurance plan when traveling outside Canada?
At UHN, employees are offered a group health care plan with Sun Life Financial. It is important to understand what is covered with each option before you travel so you can make the decision about whether to buy additional insurance. For example, all Sun Life plans carry some form of travel insurance, but it does not cover people with a pre-existing condition or pregnant women who are four weeks away from their due date.
If you do not have a copy of your health insurance plan, please contact your UHN HR representative or call the UHN Employee Helpline: 416-340-5995 for details on your benefit coverage.
For more information, visit Sun Life Financial
When to purchase additional health insurance?
If you are not fully covered by your work plan, are traveling outside of Canada, and/or have a pre-existing condition, you should purchase additional health insurance.
Also, if you are planning to travel in areas where the cost of health care is high – like the United States – it is highly recommended that you purchase additional health insurance to make sure you are completely covered.
Additional health insurance can be purchased through the bank or from an insurance company in Canada and must be done in advance of your trip.
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