Personal Health Navigator

Why you may need private health insurance when travelling in Canada

Emergency room signQUESTION: My grandmother came to visit me in Alberta from her home in Ontario. During her stay, she had a stroke and was paralyzed on the left side of her body. She is currently at a hospital in Edmonton. Now the big issue comes down to the mighty buck:  Who will pay for the air transfer back to Ontario?  She has been told that she should have bought health insurance and she is responsible for the cost. It was my belief that, as long as you are a Canadian citizen, the health-care system looks after you.  Aren’t your health-care costs covered when you’re in another province?

ANSWER:  Unfortunately, only some medical expenses are covered when you are in another province. If you need to be seen by a doctor or visit a hospital emergency department, then your home province will pay for those services.  But any extras – such as an air ambulance flight back home – are not included.

“Typically this coverage is for medically-necessary insured physician and hospital services only,” David Jensen, a spokesperson for the Ontario Ministry of Health and Long-Term care, explained in an email.

“Therefore, when travelling outside of Ontario but within Canada, the ministry recommends that you obtain private supplementary health insurance for non-physician, non-hospital and uninsured services.”

Mr. Jensen’s advice may come as a surprise to you and other Ontario residents. After all, most people know they may need supplemental health insurance when going abroad. But many Canadians don’t realize they may need to buy private health insurance when travelling within their own country.

We tend to think of Medicare as a national program.  And under the federal Canada Health Act, Canadian citizens are entitled to medically-necessary services regardless of where they are in the country. But the administration of health care is a provincial responsibility under our Constitution.  That means we have separate programs for each of the provinces and territories.

There are interprovincial agreements that enable Canadians to receive medical treatment outside of their home province. However, as you have discovered, there are gaps in the coverage. Without private insurance, you could find yourself on the hook for some unexpected expenses.

So, you might ask, what specific services are covered by these interprovincial agreements? The answer is best summed up by the term “medically necessary.” For example, if you are experiencing a heart attack or have been in a serious accident and need immediate medical attention, then those expenses are covered. That would include a stay in a publicly-funded hospital and any tests or procedures you may need while you’re a hospital patient.

In order to ensure your home province picks up the tab, Mr. Jensen says you must show your provincial health card when you go through the hospital’s registration process.

In most cases, the hospital will send your medical bills to the Ontario Ministry of Health for payment.

But a doctor may bill you directly. Physicians in other provinces have two options when treating a patient from Ontario:  They can send their invoice to the Ontario Ministry of Health or they can ask the patient to pay.

If the doctor gives you the bill, you can seek reimbursement later by submitting the original receipt(s) to the ministry.  But there is a catch – the reimbursement will be based on the rates listed in the Ontario Schedule of Benefits for Physicians Services.

In other words, Ontario will compensate you up to the rate normally paid to an Ontario physician for performing the same service.  So, if the doctor charges above the Ontario rate, you’re going to be out of pocket the difference.  (Of course, if the doctor charges less than the Ontario rate, then you’ll get back the amount you were billed.)

Mr. Jensen also points out that Ontario won’t cover payments made to health-care centres or hospitals that are private.  It must be a publicly-funded facility.

You can verify, in advance, whether it’s publicly-funded or private by calling the ministry’s toll-free number: 1-888-359-8807.

Mr. Jensen has one last bit of advice for Ontarians travelling to other provinces – if you need medical assistance “ensure that you keep copies of all your receipts.”

It’s also worthwhile mentioning that some people have extended health coverage through their workplace as part of an employee-benefit program. As well, certain credit cards provide various forms of health and travel insurance.

The next time you’re planning a trip – whether it be in Canada or abroad – you may want to check into your existing coverage to determine whether you need to top it up.

About the author

Paul Taylor

Paul Taylor retired from his role as Sunnybrook's Patient Navigation Advisor in 2020. From 2013 to 2020, he wrote a regular column in which he provided advice and answered questions from patients and their families. Follow Paul on Twitter @epaultaylor