Ontario (ON)
Ontario Health Coverage
Out of Province Coverage

Within Canada but Out of Province

Insured benefits for hospital, emergency inpatient treatment, or out-patient treatment following an accident, are payable at the ward rates charged.

Ambulance service outside the province of Ontario are not covered by OHIP.

Under a federal-provincial agreement, out-of-province recipients will be insured for all benefits offered by the province in which they are treated. The exceptions are services provided by Chiropractors, Optometrists, Podiatrists, Osteopaths and Quebec physician's services.

If required to pay for health care received outside Ontario, but within Canada, you may apply for consideration of reimbursement from the Ministry.

Out of Country Coverage

The costs for services rendered by eligible out-of-country hospitals and health-care facilities are reimbursed for medically necessary emergency in-patient and out-patient services. In the case of in-patient services it must also be demonstrated that the patient would have been admitted on an emergency basis to a public hospital in Ontario for the same services. In addition, emergency services for the purpose of an acute, unexpected condition, illness, disease or injury that arises while the individual is outside Canada and that required immediate attention.

The Ministry will pay a maximum of:

Only services rendered at licensed hospital and health care facilities which routinely perform both complex medical and complex surgical procedures, in the case of in-patient services, and complex medical or complex surgical procedures, in the case of out-patient services, are eligible for reimbursement.

Medically necessary out-of-country physicians and other eligible practitioner services will continue to be reimburses at the rates listed in the Ontario Ministry of Health's schedules of benefits or the amount billed, whichever is less. Such reimbursement will continue to be limited to services provided on an emergency basis.

Ambulance service outside the province of Ontario are not covered by OHIP.

The reduced rates will not apply to Ontario residents that must travel out of country for medical treatment, if the treating physician obtains prior written approval from the Ministry before the patient leaves Ontario. In these cases, the Ministry will continue to pay the full cost of treatment if it is not available in Ontario, or, if the patient's wait for treatment would be life threatening.

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