Travel Insurance – Detailed Information

Did you know that when travelling outside of Canada, OHIP will not pay the same medical expenses that are covered in Ontario? If you are an Ontario resident and you’re insured under OHIP, you’re entitled to very limited funding for a certain range of medical services when travelling outside of Canada. For this reason, you are strongly advised to purchase additional health insurance every time you leave Canada and ensure that the supplementary insurance you have purchased provides adequate coverage.

Why?

OHIP will pay very limited amounts for physician services and hospital/health facility services – and only if certain conditions are met. Under Ontario’s Health Insurance Act and regulations, physician services are subject to different conditions than hospital services.

OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an ’emergency,’ there are a number of criteria that must be satisfied. These criteria are set by regulation and include the conditions listed below that must be met :

  • the treatment must be medically necessary, and
  • the treatment must be performed at a licensed hospital or licensed health facility, and
  • the treatment must be rendered in relation to an illness, disease, condition or injury that :
    • is acute and unexpected, and
    • arose outside of Canada, and
    • requires immediate treatment.

These provisions are intended and designed to provide a very limited amount of funding for the medical treatment of insured residents of Ontario – if they incur an unexpected illness, disease, condition or injury while they are outside of Canada. If the illness, disease, condition or injury arises before you leave Canada, or if it is not acute or unexpected, no payment can be made.

OHIP does not cover:

  • treatment that is medically unnecessary
  • health services that are rendered at a facility that is not a licensed hospital or health facility
  • treatment that is generally accepted by the medical profession in Ontario as being experimental or for research or part of a study
  • treatment rendered for an illness, disease condition or injury that arose in Canada
  • ambulance services or transportation costs
  • other services specifically set out in the regulations as uninsured or not listed as insured

Types of Travel Policies:

  • Multi-trip Worldwide
  • Multi-trip within Canada
  • Single Trip Worldwide
  • Single Trip within Canada
  • Single Trip Worldwide excluding USA
  • Student Medical Plan

Pre-Existing Coverage:

59 Years of Age or Younger: No Stability period for trips 35 days or less*, 90-day stability period for trips greater than 35 days.

60-74 Years of Age: 180-day stability period for all trip lengths.

75-89 Years of Age: 365-day stability period for all trip lengths.

*Conditions and or symptoms that have worsened on the date of departure, or at any time within the seven days prior to the date of departure, other than minor ailments, will not be covered.

Family rates are available for individuals up to 59 years of age. Please read policy wordings for full coverage details or discuss with your broker.

Student Medical Plan

Students travelling to other countries for studies will need to have a plan to cover unexpected medical costs while abroad. Below is a summary of coverage offered by this plan:

  • Maximum limit for coverage is $2 Million.
  • Insurance company pays emergency fees directly to the hospital or doctor of your choice.
  • You must be undergoing treatment for a medically necessary and for an acute, sudden and unexpected sickness or accident.
  • Covers hospital confinement, ambulance services, X-rays, and services of a physician. Prescriptions are covered to a max of $10 000 of a 30-day supply. There is coverage for rental of medical appliances. Private duty nursing has a maximum coverage amount of $15000 when prescribed by attending physician, only in lieu of hospitalization.
  • $600 for chiropractor, physiotherapist, acupuncture, etc services. (Physician referral required.)
  • Emergency air transportation.
  • Annual physician visit.
  • Non-emergency treatment is covered to a maximum of $3000. – Treatment must be a direct result of the initial emergency medical treatment.
  • Maternity: $25000 for prenatal care.
  • Impacted wisdom teeth: $150 per tooth for extraction when medically necessary.
  • Emergency Dental: $5000 maximum for an accident requiring the repair of natural teeth.
  • Expenses for dental pain other than that caused by an accident: $600.
  • Repatriation: In the event of your death, $15000 maximum for preparation and return of your body.
  • Burial or cremation: $5000 maximum.
  • Transportation cost of one family member to identify remains: $5000 maximum.
  • Out-patient care from a psychiatrist or psychologist: $1000.
  • Psychiatric or psychological in-patient hospitalization: $10000.
  • Flying a family member in to be with you while you are in hospital if a physician deems it necessary: $5000 maximum.
  • Family member meals and accommodation: $150 per day to $1500 maximum.
  • One eye exam visit.
  • $200 for glasses or contact lenses, hearing aids as required by an accident.
  • Qualified private tutoring if hospitalization of 30 days or more is required: $20 an hour to a $400 maximum.
  • Death or dismemberment as a result of accident during a covered trip: $10 000 maximum.