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Everything You Need to Know About Health Insurance For Canadian Citizens Returning to Ontario

on 24 Dec, 2018

It’s estimated that nearly 3 million Canadians are living outside of Canada’s borders.

When those Canadians come home, they may be surprised to learn that their healthcare has been put on hold. Those who travel outside of Canada for more than 7 months may find themselves in a similar predicament.

So how does health insurance for Canadian citizens returning to Ontario work? If you’re returning to the country after an extended stay abroad, you need to know what to do in an emergency health situation.

To find out if you’re still covered – and what to do when you’re not – keep reading.

When Does Canadian Health Insurance Become Invalid?

Generally speaking, your OHIP coverage can be put on hold if you’ve been out of the country for more than 7 months in as 12 months period. However, you’re able to keep your coverage even if you’ll be outside of Canada for up to 2 years. You qualify for coverage if:

  • you have a valid Ontario health care
  • Ontario is your primary residence
  • you’re in Ontario for at least 153 days in each of the 2 years immediately before leaving Canada

To make sure you’re coverage stays valid, you’ll have to visit a ServiceOntario center. Bring along your health card and proof of residency to update your status.

In the case of Canadians citizens living outside Canadian borders or more than 1 year at a time, there’s a waiting period imposed. The waiting period can be up to 3 months. During this time, you’re not covered under a Canadian healthcare plan.

Exemptions

Members of the military, as well as their family, are subject to different rules in terms of health care coverage. Canadian citizens whoa re adopting a child from outside of the country may also be exempt from healthcare coverage guidelines.

There are other groups that qualify for an exemption from these guidelines. You can contact the Service Ontario INFOline or visit a ServiceOntario Center for more information on exemptions from the 3 month waiting period.

Health insurance for Canadian Citizens Returning to Ontario Reapplication Process

Reapplying for healthcare coverage is a fairly easy process. Bring a completed application form and 3 original documents from the OHIP document list to a ServiceOntario center. Eligible documents include:

  • A document proving Canadian citizenship (i.e. Passport, birth certificate, permanent resident card, etc.).
  • A document proving residency in Ontariio (i.e. Ontario driver license, Ontario Photo Card, etc.).
  • A document proving who you are and include both your name and signature (i.e. credit card, driver license, Ontario Photo Card, Canadian Immigration Identification Card, etc.).

The beginning of the 3 month waiting period is the date of re-establishing residency in Ontario. In addition, you may have to be in Ontario for at least 153 of the first 183 days of residency. In other words, you can’t be outside of Ontario for longer than 30 days in your first 6 months after establishing residency in the province.

What Can You Do In the Meantime?

If you’ve been outside of Canada for longer than the allowed period and have to wait for a hold to be taken off your coverage, you’re not covered by a healthcare plan. That means that should something happen, you’re responsible for healthcare costs from your own pocket. That’s why it’s a good idea to have supplementary medical insurance that will cover unexpected healthcare costs while you wait for your OHIP.

What OHIP Covers and for How Long

If you’re traveling for less than the allowed time period, OHIP does cover some health care costs while traveling outside of Canada. To be covered, you must:

  • live in Ontario for less than 6 months and be away for less than 31 days
  • live in Ontario for more than 6 months and be away for less than 213 days in a 1 year period

To qualify for coverage while abroad, you must have a valid Ontario health card. To be considered valid, the card must not be expired. It should also contain correct and updated personal information – so make sure you update your address should you move or your name should you get married.

OHIP only covers some health care costs incurred outside of the country. In order to receive coverage for a treatment or service, it must meet certain criteria. These include:

  • the treatment or service is medically necessary
  • the treatment or service came from a licensed hospital or health facility
  • the treatment or service was for an illness, disease, or condition that was acute/unexpected, not preexisting, and required immediate attention

Keep all your medical bills and records when receiving medical treatment abroad.

OHIP Reimbursement

If you’ve received treatment abroad while you were eligible or OHIP coverage, you’ll be reimbursed for your costs. In order to qualify for reimbursement, a claim must be submitted to OHIP within 12 months of receiving and paying for the medical treatment.

In order to submit a claim with OHIP, follow the below steps:

  • Fill out the claims form (i.e the Out of Province/Country Claims Submission form)
  • Include a statement with information regarding:
    • admittance date
    • discharge date
    • service or treatment descriptions
    • the nature of the complication (why treatment was necessary)
    • the nature of the treatment of service
    • discharge diagnosis
    • information on any tests or diagnostics performed (laboratory, radiological, etc.)
    • itemized fees for every service and treatment received
    • health card number
    • name and current address

Keep any receipts and other records and include them in your statement. Send any receipts to the hospital or health facility as well as any receipts for the doctor or surgeon with your claim.

Are You Covered?

If you’ve been outside of Ontario for more than 7 months, your health coverage under OHIP has likely been put on hold. That means you’ll have to reapply for health coverage at a ServiceOntario Center and wait up to 3 months before you have health insurance.

In the meantime, you need to ensure you’re covered in the case of emergency. To find health insurance for Canadian citizens returning to Ontario, get a quote from us today.

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